Healthcare Provider Details

I. General information

NPI: 1679680722
Provider Name (Legal Business Name): CRAIG KERBO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 DUBLIN SQUARE RD STE A
ASHEBORO NC
27203-8601
US

IV. Provider business mailing address

PO BOX 5418
ASHEBORO NC
27204-5418
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-3700
  • Fax: 336-626-4100
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-629-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10657
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: