Healthcare Provider Details

I. General information

NPI: 1336713650
Provider Name (Legal Business Name): GAGE A KERNS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4249 HIGHWAY 411 STE 4
MADISONVILLE TN
37354-1544
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 423-442-4034
  • Fax:
Mailing address:
  • Phone: 423-238-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17127
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13694
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: