MEDICARE: JON KERN MSPT

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	23785

General Provider Information

NPI Number	:	1811670151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON KERN MSPT

Provider Business Mailing Address
First Line	:	5963 LA PLACE CT STE 111
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-8822
Country	:	US
Telephone Number	:	760-460-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	5963 LA PLACE CT STE 111
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-8822
Country	:	US
Telephone Number	:	760-460-1203
Fax Number	:

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

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “ JON KERN MSPT” Practice Location

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