Provider Demographics
NPI:1689943409
Name:LABRASH, KENDALL JOAN (PT)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:JOAN
Last Name:LABRASH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:JOAN
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4251 LAHMEYER RD.
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815
Mailing Address - Country:US
Mailing Address - Phone:260-432-4700
Mailing Address - Fax:260-459-9262
Practice Address - Street 1:4251 LAHMEYER RD.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:260-482-7800
Practice Address - Fax:260-484-0273
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001840A2255A2300X
IN05011404A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer