Provider Demographics
NPI:1588918148
Name:HARRING, KENDRA BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:BROOKE
Last Name:HARRING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1226
Mailing Address - Country:US
Mailing Address - Phone:269-792-4440
Mailing Address - Fax:269-792-6981
Practice Address - Street 1:709 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1226
Practice Address - Country:US
Practice Address - Phone:269-792-4440
Practice Address - Fax:269-792-6981
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist