Healthcare Provider Details

I. General information

NPI: 1306620455
Provider Name (Legal Business Name): DAWN KERSHNER PT ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIERRA COLLEGE DR
GRASS VALLEY CA
95945-5082
US

IV. Provider business mailing address

14381 SUNROCK RD
NEVADA CITY CA
95959-9049
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-2320
  • Fax:
Mailing address:
  • Phone: 831-334-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA48069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: