Provider Demographics
NPI:1912725334
Name:KENDALL, GARRETT (CPT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:KENDALL
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69281 M 62
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-8664
Mailing Address - Country:US
Mailing Address - Phone:708-990-7294
Mailing Address - Fax:
Practice Address - Street 1:69281 M 62
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-8664
Practice Address - Country:US
Practice Address - Phone:708-990-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1065050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation