Healthcare Provider Details

I. General information

NPI: 1376822718
Provider Name (Legal Business Name): KERI TODD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 J L WHITE DR STE 110
JASPER GA
30143-4897
US

IV. Provider business mailing address

PO BOX 4744
CHATTANOOGA TN
37405-0744
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-9080
  • Fax: 706-692-1199
Mailing address:
  • Phone: 423-802-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000006358
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP062348T
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: