Provider Demographics
NPI:1548527260
Name:THOMAS, KENDAL MAE (PT)
Entity type:Individual
Prefix:
First Name:KENDAL
Middle Name:MAE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KENDAL
Other - Middle Name:MAE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 PARK PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHIPPENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17257-9806
Mailing Address - Country:US
Mailing Address - Phone:717-477-8030
Mailing Address - Fax:717-477-8040
Practice Address - Street 1:91 S HIGH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWVILLE
Practice Address - State:PA
Practice Address - Zip Code:17241-1405
Practice Address - Country:US
Practice Address - Phone:717-776-1058
Practice Address - Fax:717-776-1078
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027722420001Medicaid
PA247426V9XMedicare PIN