Provider Demographics
NPI:1821223751
Name:HENDERSHOT, AUBREE L (DPT)
Entity Type:Individual
Prefix:
First Name:AUBREE
Middle Name:L
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AUBREE
Other - Middle Name:L
Other - Last Name:MULLINIX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:638 NW JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8278
Mailing Address - Country:US
Mailing Address - Phone:816-836-0800
Mailing Address - Fax:816-836-3229
Practice Address - Street 1:638 NW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8278
Practice Address - Country:US
Practice Address - Phone:816-836-0800
Practice Address - Fax:816-836-3229
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04235225100000X
MO2009027340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist