Provider Demographics
NPI:1235332693
Name:PEERY, KENDRA LEE (PTA)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:LEE
Last Name:PEERY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MOUND CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66056-5253
Mailing Address - Country:US
Mailing Address - Phone:913-837-0646
Mailing Address - Fax:
Practice Address - Street 1:811 LOCUST ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:KS
Practice Address - Zip Code:66056-5253
Practice Address - Country:US
Practice Address - Phone:913-837-0646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1400244225200000X
MO2000157974225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant