Provider Demographics
NPI:1053882308
Name:HALL, KENDLE NICHOLE
Entity type:Individual
Prefix:MRS
First Name:KENDLE
Middle Name:NICHOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6897 STATUM RD
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MD
Mailing Address - Zip Code:21655-2016
Mailing Address - Country:US
Mailing Address - Phone:410-829-9000
Mailing Address - Fax:
Practice Address - Street 1:12 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3657
Practice Address - Country:US
Practice Address - Phone:410-763-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3990225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant