1598072845 NPI number — DR. KENDRA CORDERO NELSON D.P.T.

Table of content: DR. KENDRA CORDERO NELSON D.P.T. (NPI 1598072845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598072845 NPI number — DR. KENDRA CORDERO NELSON D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
KENDRA
Provider Middle Name:
CORDERO
Provider Name Prefix Text:
DR.
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:
CORDERO
Provider Other First Name:
KENDRA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598072845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 RIVER ROAD
Provider Second Line Business Mailing Address:
UNIVERSITY HEALTH CENTER PHYSICAL THERAPY DEPARTMENT
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-542-8634
Provider Business Mailing Address Fax Number:
706-583-0217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 RIVER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-542-8634
Provider Business Practice Location Address Fax Number:
706-583-0217
Provider Enumeration Date:
09/08/2010

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:  PT37041 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT010301 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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