Provider Demographics
NPI:1194955922
Name:KINEARD, KENDALL
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:KINEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719B SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3237
Mailing Address - Country:US
Mailing Address - Phone:864-963-9229
Mailing Address - Fax:864-963-2790
Practice Address - Street 1:719B SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3237
Practice Address - Country:US
Practice Address - Phone:864-963-9229
Practice Address - Fax:864-963-2790
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist