Provider Demographics
NPI:1073760146
Name:KERNEKLIAN, BETH CHRISTINE (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:CHRISTINE
Last Name:KERNEKLIAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:CHRISTINE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8936 77TH TER E UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6419
Mailing Address - Country:US
Mailing Address - Phone:941-758-7300
Mailing Address - Fax:
Practice Address - Street 1:8936 77TH TER E UNIT 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-6419
Practice Address - Country:US
Practice Address - Phone:941-758-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA. 05235225200000X
FL91105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant