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General NPI Number Information
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NPI Number | 1396918421
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Entity Type | Organization
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Legal Business Name | TERRY KERN PHYSICAL THERAPY
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 5971 JEFFERSON ST NE STE 102
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3413
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Country | US
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Telephone | 505-761-0016
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Fax | 505-761-0025
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Provider Business Mailing Address
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Address Line | 5971 JEFFERSON ST NE STE 102
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3413
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Country | US
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Telephone | 505-761-0016
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Fax | 505-761-0025
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Authorized Official
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Title or Position | OWNER
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Name | TERRY KERN
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Credential | P.T.
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Telephone | 505-761-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 515
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License Number State | NM
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