Healthcare Provider Details

I. General information

NPI: 1225104722
Provider Name (Legal Business Name): KERRY ANN FLEMING PT LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 W LAS TUNAS DR
SAN GABRIEL CA
91776
US

IV. Provider business mailing address

1848 N MICHIGAN AVE
PASADENA CA
91104
US

V. Phone/Fax

Practice location:
  • Phone: 626-570-6587
  • Fax:
Mailing address:
  • Phone: 626-570-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberLAC3801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: