Provider Demographics
NPI:1164925475
Name:O'CONNOR, KERRI L (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:L
Last Name:O'CONNOR
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 1:20 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-1628
Mailing Address - Country:US
Mailing Address - Phone:908-303-5846
Mailing Address - Fax:
Practice Address - Street 1:20 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1628
Practice Address - Country:US
Practice Address - Phone:908-303-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01255300261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy