Kendra Alexis Deberry PTA

NPI 1104847094 - Physical Therapy Assistant - 225200000X

NPI Details
NPI 1104847094
Gender Female
Enumeration Date 07/23/2006
Last Updated 07/08/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
5600 GOODMAN RD STE D
OLIVE BRANCH MS, 38654-7002, US
Phone (662) 895-5454
Fax (662) 895-4546
Business Location
5600 GOODMAN RD STE D
OLIVE BRANCH MS, 38654-7002, US
Phone (662) 895-5454
Fax (662) 895-4546
Toxanomy
Taxonomy Code 225200000X
License State Mississippi
License Number PA2517
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According to our database, Mr. Kendra Alexis Deberry PTA NPI is 1104847094, taxonomy code is 225200000X and license number is PA2517, license state is located at Mississippi. Kendra Alexis Deberry PTA physically located at 5600 Goodman Rd Ste D, Olive Branch MS, 38654-7002. NPI Number Kendra Alexis Deberry PTA has the Individual type.

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1104847094 NPI number is provided on an as is basis without warranty of any kind. 1104847094 is maintained by the National Plan & Provider Enumeration System. The contents of Kendra Alexis Deberry PTA are for informational purposes only.