Provider Demographics
NPI:1063465680
Name:KERN & ASSOC PT
Entity Type:Organization
Organization Name:KERN & ASSOC PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:W
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT OCS
Authorized Official - Phone:310-315-9711
Mailing Address - Street 1:2901 WILSHIRE BLVD
Mailing Address - Street 2:440
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4901
Mailing Address - Country:US
Mailing Address - Phone:310-315-9711
Mailing Address - Fax:310-315-9349
Practice Address - Street 1:2901 WILSHIRE BLVD
Practice Address - Street 2:440
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4901
Practice Address - Country:US
Practice Address - Phone:310-315-9711
Practice Address - Fax:310-315-9349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W14841Medicare ID - Type Unspecified