Provider Demographics
NPI:1144855917
Name:KERR, RILEY FORD (PT, DPT, ATC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:FORD
Last Name:KERR
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 CABRILLO PARK DR APT E
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3125
Mailing Address - Country:US
Mailing Address - Phone:714-914-4121
Mailing Address - Fax:
Practice Address - Street 1:2925 AIRWAY AVE STE J
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6029
Practice Address - Country:US
Practice Address - Phone:949-590-9350
Practice Address - Fax:714-361-2606
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2980892255A2300X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer