Provider Demographics
NPI:1467696971
Name:WHERRY, KORDULA (LMT)
Entity Type:Individual
Prefix:MS
First Name:KORDULA
Middle Name:
Last Name:WHERRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 SCHULZE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3446
Mailing Address - Country:US
Mailing Address - Phone:254-368-7452
Mailing Address - Fax:
Practice Address - Street 1:2100 E STAN SCHLUETER LOOP
Practice Address - Street 2:SUITE J
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3807
Practice Address - Country:US
Practice Address - Phone:254-368-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT030104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist