Provider Demographics
NPI:1134451834
Name:KINDER, KATHY (NCMT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:KINDER
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4965 STONE FALLS CTR STE 7
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7802
Mailing Address - Country:US
Mailing Address - Phone:618-624-9384
Mailing Address - Fax:618-624-9386
Practice Address - Street 1:4965 STONE FALLS CTR STE 7
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-7802
Practice Address - Country:US
Practice Address - Phone:618-624-9384
Practice Address - Fax:618-624-9386
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001254172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist