Healthcare Provider Details

I. General information

NPI: 1871644104
Provider Name (Legal Business Name): JAMIE RAE KERSTIENS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 BUFFALO RD
LAWRENCEBURG TN
38464-4809
US

IV. Provider business mailing address

213 RIDDLE LN
LORETTO TN
38469-2232
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-9418
  • Fax:
Mailing address:
  • Phone: 931-853-6579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA3433
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: