Provider Demographics
NPI:1205848223
Name:KERSHAW, ADAM B (MPT, OCS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:B
Last Name:KERSHAW
Suffix:
Gender:M
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6108 NW SPECTRUM CT
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-6126
Mailing Address - Country:US
Mailing Address - Phone:360-479-8477
Mailing Address - Fax:
Practice Address - Street 1:6108 NW SPECTRUM CT
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-6126
Practice Address - Country:US
Practice Address - Phone:360-479-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8866598Medicare PIN