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General NPI Number Information
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NPI Number | 1770679011
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Entity Type | Individual
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Provider Name | KRISTY RENEE KERKELA P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 820 CARP RIVER LN SUITE 2
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City | ISHPEMING
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State | MI
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Zip | 49849-3187
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Country | US
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Telephone | 906-204-7400
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Fax | 906-204-7402
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Provider Business Mailing Address
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Address Line | 463 NORTH RD
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City | NEGAUNEE
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State | MI
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Zip | 49866-9512
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Country | US
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Telephone | 906-458-0421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501011919
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License Number State | MI
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