Provider Demographics
NPI:1992296941
Name:HERONEMUS, DEVAN MYRINDA (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:MYRINDA
Last Name:HERONEMUS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DEVAN
Other - Middle Name:MYRINDA
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:10074 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-3802
Practice Address - Country:US
Practice Address - Phone:913-764-0389
Practice Address - Fax:139-764-0391
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018023462225100000X
KS11-05902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist