MEDICARE: DR. KERRI ANN WAEGELEIN DPT, OCS

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	225100000X	Physical Therapist	8158	SC

General Provider Information

NPI Number	:	1194279406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRI ANN WAEGELEIN DPT, OCS

Provider Business Mailing Address
First Line	:	1050 WOODSIDE DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-9360
Country	:	US
Telephone Number	:	845-242-8732
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 RUTLEDGE AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-5816
Country	:	US
Telephone Number	:	843-480-0908
Fax Number	:

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

Provider Enumeration Date	:	08/04/2016
Last Update Date	:	11/14/2025

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