Provider Demographics
NPI:1154389658
Name:KULP, KENDA LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:KENDA
Middle Name:LYNN
Last Name:KULP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:KENDA
Other - Middle Name:LYNN
Other - Last Name:KAUFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:140 VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013
Mailing Address - Country:US
Mailing Address - Phone:717-249-5562
Mailing Address - Fax:
Practice Address - Street 1:419 VILLAGE DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013
Practice Address - Country:US
Practice Address - Phone:717-240-0330
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000577L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant