Healthcare Provider Details

I. General information

NPI: 1346661451
Provider Name (Legal Business Name): KERRY PICKERING PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 08/20/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 WARNER AVE STE 104
HUNTINGTON BEACH CA
92647
US

IV. Provider business mailing address

2621 E JACARANDA AVE
ORANGE CA
92867-6224
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-9887
  • Fax: 949-216-5980
Mailing address:
  • Phone: 714-485-9887
  • Fax: 949-216-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number39710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: