MEDICARE: MRS. KERRI LYNN CLEAVER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	8967	NC

General Provider Information

NPI Number	:	1073727913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KERRI LYNN CLEAVER DPT

Provider Business Mailing Address
First Line	:	5708 QUAIL COVEY LN
Second Line	:
City	:	WENDELL
State	:	NC
Zip	:	27591-9503
Country	:	US
Telephone Number	:	919-217-5089
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 LAKE BOONE TRL STE 2E
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-7518
Country	:	US
Telephone Number	:	919-781-3978
Fax Number	:	919-781-4315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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