MEDICARE: LUBOV CHARITY KERRIN LPTA

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	225200000X	Physical Therapy Assistant	2306603560	VA
2	225200000X	Physical Therapy Assistant	CP038683A	NC

General Provider Information

NPI Number	:	1134533276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUBOV CHARITY KERRIN LPTA

Provider Business Mailing Address
First Line	:	116 TOCCOA AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-4568
Country	:	US
Telephone Number	:	540-580-2529
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 TOCCOA AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-4568
Country	:	US
Telephone Number	:	540-580-2529
Fax Number	:

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

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	03/19/2026

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