MEDICARE: CASSANDRA LEIGH KERKMAN

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	PTL.0018928	CO
2	225100000X	Physical Therapist	4696	NE

General Provider Information

NPI Number	:	1871299578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA LEIGH KERKMAN

Provider Business Mailing Address
First Line	:	PO BOX 34669
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-0669
Country	:	US
Telephone Number	:	402-932-6791
Fax Number	:

Provider Business Practice Location Address
First Line	:	2436 N 48TH ST STE 101
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68504-3627
Country	:	US
Telephone Number	:	402-325-6341
Fax Number	:

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

Provider Enumeration Date	:	02/03/2023
Last Update Date	:	08/29/2024

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Directions to “ CASSANDRA LEIGH KERKMAN ” Practice Location

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