Individual
KENDALL E WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1615 RIDENOUR BLVD NW STE 204, KENNESAW, GA 30152-4464
(770) 580-8070
(770) 285-8751
Mailing address
8541 E ANDERSON DR STE 100, STE 100, SCOTTSDALE, AZ 85255-5430
(480) 585-6810
(480) 585-6910
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
12414
AZ
225100000X
Physical Therapist
Primary
PT013169
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT013169
PHYSICAL THERAPY LICENSE
GA
Enumeration date
09/19/2016
Last updated
10/20/2017
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