Basic Information
| Provider Information | |||||||||
| NPI: | 1144859810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | KENDYLL | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 84TH ST SE | ||||||||
| Address2: | |||||||||
| City: | CALEDONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493168359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193404851 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | HASTINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490581026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699459564 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2020 | ||||||||
| LastUpdateDate: | 04/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251G0304X | 5501016767 | MI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No ID Information.