Provider Demographics
NPI:1841013216
Name:HERNDON, SHERA J (LMT)
Entity type:Individual
Prefix:
First Name:SHERA
Middle Name:J
Last Name:HERNDON
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 1:6912 HOLLY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3025
Mailing Address - Country:US
Mailing Address - Phone:502-744-5240
Mailing Address - Fax:
Practice Address - Street 1:10424 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6319
Practice Address - Country:US
Practice Address - Phone:502-744-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist