1558504415 NPI number — MRS. KENDRA DENISE REEDER D.P.T.

Table of content: MRS. KENDRA DENISE REEDER D.P.T. (NPI 1558504415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558504415 NPI number — MRS. KENDRA DENISE REEDER D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEDER
Provider First Name:
KENDRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALBACH
Provider Other First Name:
KENDRA
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558504415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5814 E LEISURE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAVE CREEK
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85331-9102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-809-4043
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33016 N 60TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85266-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-575-2000
Provider Business Practice Location Address Fax Number:
480-488-7055
Provider Enumeration Date:
04/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  7941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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