Provider Demographics
NPI:1619700812
Name:ANDERSON, KENDALL ANASTASIA (DPT)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:ANASTASIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 S LAKE DR STE H
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-6736
Mailing Address - Country:US
Mailing Address - Phone:803-957-0404
Mailing Address - Fax:803-957-0468
Practice Address - Street 1:1787 S LAKE DR STE H
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6736
Practice Address - Country:US
Practice Address - Phone:803-957-0404
Practice Address - Fax:803-957-0468
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
SC12533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist