Provider Demographics
NPI:1386636793
Name:ABERNATHY, KATHY S (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:S
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BUTLER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1629
Mailing Address - Country:US
Mailing Address - Phone:660-385-6244
Mailing Address - Fax:660-385-4821
Practice Address - Street 1:106 BUTLER ST
Practice Address - Street 2:SUITE C
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1629
Practice Address - Country:US
Practice Address - Phone:660-385-6244
Practice Address - Fax:660-385-4821
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist