Provider Demographics
NPI:1306478441
Name:PEETERS, KENDRA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:PEETERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:51761 115TH ST
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-2083
Mailing Address - Country:US
Mailing Address - Phone:218-205-1826
Mailing Address - Fax:
Practice Address - Street 1:311 JEFFERSON ST N
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1308
Practice Address - Country:US
Practice Address - Phone:218-631-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist