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NPI Code Detail

MEDICARE: KASEY RAE KERR PTA

MEDICARE: KASEY RAE KERR PTA
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
1225200000XPhysical Therapy Assistant2951OK

General Provider Information

NPI Number : 1578284717
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASEY RAE KERR PTA
Provider Business Mailing Address
First Line : 1209 W HEFNER RD APT 452
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-7019
Country : US
Telephone Number : 405-306-0552
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1240
Country : US
Telephone Number : 405-875-0040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2022
Last Update Date : 09/06/2022

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Directions to “ KASEY RAE KERR PTA” Practice Location

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