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General NPI Number Information
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NPI Number | 1114341997
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Entity Type | Individual
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Provider Name | KATHLEEN HERNDON PT
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Gender | Female
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 605 N COMMERCIAL AVE
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City | SAINT CLAIR
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State | MO
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Zip | 63077-1103
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Country | US
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Telephone | 636-629-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 AUBURN HILLS DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-2449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 100401
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License Number State | MO
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