Brooks F Kenderdine, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60944647 Issued in WA

Practice address

16222 Meridian E Ste 101
Puyallup, WA 98375-6332

Phone

(253) 864-7595

Fax

(253) 864-0457

NPI assigned

May 3, 2019

Reactivated

Oct 14, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• The Path Rehab & Performance LLC

  • Physical Therapist
  • Pacific, WA
  • NPI 1326622002
  NPD Authorized official
• Multicare Health System

  • Family Medicine Physician
  • Auburn, WA
  • NPI 1013969195

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1556841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1144885294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 TACOMA MALL BLVD STE 300",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984096828",
            "telephone_number": "253-581-5200",
            "fax_number": "253-581-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16222 MERIDIAN E STE 101",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983756332",
            "telephone_number": "253-864-7595",
            "fax_number": "253-864-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDERDINE",
        "first_name": "BROOKS",
        "middle_name": "F",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-03",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "deactivation_date": "2021-05-10",
        "reactivation_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60944647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Elizabeth Kelley, FNP
• Kellie Eleazer
• Shannon Kelsch, AAHCC
• Paige Elizabeth Kelso-Znak, MSW
• Kelvin K Ma MD Inc PS
• Thomas P Kennedy, MD
• Kenneth Hilliard DPM
• Kendra Elizabeth Mikatarian Kent, NP
• Penelope Anita Kent, OTR/L
• Chan Thavy Keo

• Physical Therapist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.