KENDRICK WIDEMON – Physical Therapist, NPI 1942630116

KENDRICK WIDEMON is a healthcare provider. based in Crowley, Texas. specializing in Physical Therapist. They hold a License No. 1172043 (TX). The NPI Number for KENDRICK WIDEMON is 1942630116

Main info

Male
20 Years Of Experience
Accepts Medicare Assignment
Name
KENDRICK WIDEMON
NPI
1942630116
Phone
(903) 830-7993
Address
1125 COTTONWOOD DR
Enumeration Date
25 November 2013
Last Update Date
25 November 2013

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8179008441
Graduation Year
2006 (20 years ago)
PAC ID
4587896576
Group Practice PAC ID
6608104450
Professional Enrollment ID
I20140404001696
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience38
Completeness75
Years active:12State licenses:1Digital endpointsOther names

Provider Addresses for KENDRICK WIDEMON

  • 1125 COTTONWOOD DR

    CROWLEY, TX 760364308

    Phone: (903) 830-7993

    Type: Mailing

  • 5728 MOON FLOWER CT

    KELLER, TX 76244

    Phone: (817) 337-9548

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 76036)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6608104450View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for KENDRICK WIDEMON?
KENDRICK WIDEMON — NPI 1942630116 — is the standard way to identify this listing.
Can I rely on KENDRICK WIDEMON being an active provider?
As of the registry snapshot, KENDRICK WIDEMON is marked active.
What is KENDRICK WIDEMON best known for clinically?
Directory data describes KENDRICK WIDEMON with Physical Therapist. Clinical services aligned with this taxonomy classification.
Where should I expect KENDRICK WIDEMON on a map?
Expect Crowley, Texas as a primary anchor for KENDRICK WIDEMON unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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