Healthcare Provider Details

I. General information

NPI: 1083192785
Provider Name (Legal Business Name): CHRISTINE KERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE MAUCH

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 SPRINGDALE RD
CINCINNATI OH
45251-1331
US

IV. Provider business mailing address

1866 VANDERBILT DR
LOVELAND OH
45140-2032
US

V. Phone/Fax

Practice location:
  • Phone: 513-245-0100
  • Fax:
Mailing address:
  • Phone: 513-293-5772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT017468
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: