Healthcare Provider Details

I. General information

NPI: 1821072778
Provider Name (Legal Business Name): CLAUDIA YOLANDE KERNS PT CIIM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD SUITE 309 TAI PEDIATRIC PHYSICAL THERAPY
ENCINO CA
91436-2276
US

IV. Provider business mailing address

11481 SW HALL BV STE 201 THERAPEUTIC ASSOCIATES INC
PORTLAND OR
97223-8403
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-4071
  • Fax: 818-783-4081
Mailing address:
  • Phone: 800-219-8835
  • Fax: 503-443-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: