Individual provider Active NPI

Julie Kendro, PTA

  • Physical Therapist
  • Bedford, TX
National Provider Identifier
1114442274
Registry record updated Aug 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2123269 Issued in TX
Practice address
404 Racquet Club Blvd
Bedford, TX 76022-6408
Phone
(682) 738-3056
Fax
(682) 738-3056
NPI assigned
Aug 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2123269 TX Primary

Addresses

Primary practice location

404 Racquet Club Blvd
Bedford, TX 76022-6408

Mailing address

4837 Pershing Ave
Fort Worth, TX 76107-4929
Phone (817) 253-8288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2123269TXMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Small Hands Big Hearts Pediatric Therapy Management Inc Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502323200000",
    "number": "1114442274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4837 PERSHING AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761074929",
            "telephone_number": "817-253-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 RACQUET CLUB BLVD",
            "city": "BEDFORD",
            "state": "TX",
            "postal_code": "760226408",
            "telephone_number": "682-738-3056",
            "fax_number": "682-738-3056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDRO",
        "first_name": "JULIE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-10",
        "last_updated": "2017-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "2123269",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bedford, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.