Provider Demographics
NPI:1780485227
Name:VAROSKOVIC, KENDRA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:VAROSKOVIC
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 JETTY LN APT 312
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-1113
Mailing Address - Country:US
Mailing Address - Phone:207-766-1864
Mailing Address - Fax:
Practice Address - Street 1:102 AUTUMN HALL DR STE 220
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2057
Practice Address - Country:US
Practice Address - Phone:910-660-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-56822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer