MEDICARE: KERWIN FLORA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070019483	IL

General Provider Information

NPI Number	:	1750634630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERWIN FLORA PT

Provider Business Mailing Address
First Line	:	125 106TH AVE NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-5059
Country	:	US
Telephone Number	:	763-245-7746
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 W ARMY TRAIL RD
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1901
Country	:	US
Telephone Number	:	630-238-9235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	02/26/2013

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Directions to “ KERWIN FLORA PT” Practice Location

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