MEDICARE: MRS. CAROL ANN KERN

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	8116	OH

General Provider Information

NPI Number	:	1730308420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL ANN KERN

Provider Business Mailing Address
First Line	:	32825 SENECA DR
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-5570
Country	:	US
Telephone Number	:	440-519-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	12801 BANGOR AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-3660
Country	:	US
Telephone Number	:	216-475-8123
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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