Basic Information
| Provider Information | |||||||||
| NPI: | 1861971129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENDERSON | ||||||||
| FirstName: | KRIS | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5672 WRENWYCK PL | ||||||||
| Address2: | |||||||||
| City: | WELDON SPRING | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633041237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147078779 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 8TH ST | ||||||||
| Address2: | |||||||||
| City: | WINFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633891170 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366688188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT01804 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.