Provider Demographics
NPI:1053310490
Name:KERNS, KRISTIN GAIL (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:GAIL
Last Name:KERNS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:GAIL
Other - Last Name:GEURKINK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1687 ERRINGER RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6508
Mailing Address - Country:US
Mailing Address - Phone:805-584-8054
Mailing Address - Fax:805-584-2437
Practice Address - Street 1:1687 ERRINGER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6508
Practice Address - Country:US
Practice Address - Phone:805-584-8054
Practice Address - Fax:805-584-2437
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT25210AMedicare ID - Type Unspecified