Provider Demographics
NPI:1730903378
Name:HERGENROTHER, KATHRYN KRISTY (DPT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:KRISTY
Last Name:HERGENROTHER
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HERGENROTHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4131 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3742
Mailing Address - Country:US
Mailing Address - Phone:812-598-0919
Mailing Address - Fax:
Practice Address - Street 1:14020 OLD STATE RD STE D100
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-1167
Practice Address - Country:US
Practice Address - Phone:812-469-4770
Practice Address - Fax:812-469-4794
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015664A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist