Provider Demographics
NPI:1740545367
Name:SHULL, KENDRA LEANNE
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEANNE
Last Name:SHULL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323A HIGH SCHOOL DR
Mailing Address - Street 2:SPECIAL SERVICES - CLAIM CARE
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1525
Mailing Address - Country:US
Mailing Address - Phone:660-259-4369
Mailing Address - Fax:660-259-4992
Practice Address - Street 1:2323A HIGH SCHOOL DR
Practice Address - Street 2:SPECIAL SERVICES - CLAIM CARE
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1525
Practice Address - Country:US
Practice Address - Phone:660-259-4369
Practice Address - Fax:660-259-4992
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023139225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist