Provider Demographics
NPI:1275012973
Name:WELCH, KENDALL KENNEDY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:KENNEDY
Last Name:WELCH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:D
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2929 E 56TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7433
Mailing Address - Country:US
Mailing Address - Phone:903-918-2611
Mailing Address - Fax:
Practice Address - Street 1:2300 E 14TH ST STE 104
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4441
Practice Address - Country:US
Practice Address - Phone:214-346-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5573225100000X
TX1307929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist