Provider Demographics
NPI:1003415928
Name:HENDRIX, KAYLYNN JO (DPT)
Entity Type:Individual
Prefix:
First Name:KAYLYNN
Middle Name:JO
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 JACOBS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-1501
Mailing Address - Country:US
Mailing Address - Phone:816-878-1788
Mailing Address - Fax:
Practice Address - Street 1:1110 S 24TH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-2318
Practice Address - Country:US
Practice Address - Phone:660-259-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020004382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist