Healthcare Provider Details

I. General information

NPI: 1750476818
Provider Name (Legal Business Name): KERNAN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 LORD BALTIMORE DR EXECUTIVE PARK WEST STE 100
BALTIMORE MD
21244-2898
US

IV. Provider business mailing address

PO BOX 64744
BALTIMORE MD
21264-4744
US

V. Phone/Fax

Practice location:
  • Phone: 410-298-0990
  • Fax: 410-298-0871
Mailing address:
  • Phone: 410-298-0990
  • Fax: 410-298-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LORI PATRIA
Title or Position: DIRECTOR OF THERAPY SERVICES
Credential:
Phone: 410-298-0990