Healthcare Provider Details

I. General information

NPI: 1386636793
Provider Name (Legal Business Name): KATHY S ABERNATHY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BUTLER ST SUITE C
MACON MO
63552-1629
US

IV. Provider business mailing address

106 BUTLER ST SUITE C
MACON MO
63552-1629
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-6244
  • Fax: 660-385-4821
Mailing address:
  • Phone: 660-385-6244
  • Fax: 660-385-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00498
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: