Active NPI
Kathleen Herndon, PT
- Physical Therapist
- Saint Clair, MO
National Provider Identifier
1114341997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 100401
- Practice address
- 605 N Commercial Ave
Saint Clair, MO 63077-1103 - Phone
- (636) 629-2414
- NPI assigned
- Feb 13, 2014
- Last updated
- Mar 18, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 100401 | MO | Primary |
Addresses
Primary practice location
605 N Commercial Ave
Saint Clair, MO 63077-1103
Mailing address
1313 Auburn Hills Dr
Saint Charles, MO 63304-2449
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100401 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647561600000",
"number": "1114341997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1313 AUBURN HILLS DR",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633042449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "605 N COMMERCIAL AVE",
"city": "SAINT CLAIR",
"state": "MO",
"postal_code": "630771103",
"telephone_number": "636-629-2414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNDON",
"first_name": "KATHLEEN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-13",
"last_updated": "2022-03-18",
"certification_date": "2022-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "100401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.