Provider Demographics
NPI:1003433673
Name:CADDELL, KERRY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:CADDELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 GOLD DUST DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-5994
Mailing Address - Country:US
Mailing Address - Phone:513-403-5435
Mailing Address - Fax:
Practice Address - Street 1:6210 CLEVES WARSAW PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-4510
Practice Address - Country:US
Practice Address - Phone:513-941-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist