Provider Demographics
NPI:1386237428
Name:KENDRICK, CLAYTON ALLAN I
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:ALLAN
Last Name:KENDRICK
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 JANET LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5589
Mailing Address - Country:US
Mailing Address - Phone:903-571-9574
Mailing Address - Fax:
Practice Address - Street 1:120 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-9639
Practice Address - Country:US
Practice Address - Phone:940-648-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2156844225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant