Provider Demographics
NPI:1306967898
Name:COURTENAY, KENDRA GAYLE (PT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:GAYLE
Last Name:COURTENAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 ROLLING LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1422
Mailing Address - Country:US
Mailing Address - Phone:502-896-1193
Mailing Address - Fax:502-896-1740
Practice Address - Street 1:502 ROLLING LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1422
Practice Address - Country:US
Practice Address - Phone:502-896-1193
Practice Address - Fax:502-896-1740
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist