Provider Demographics
NPI:1225317001
Name:CHIRDON, KERRI ALISON (DPT)
Entity Type:Individual
Prefix:MS
First Name:KERRI
Middle Name:ALISON
Last Name:CHIRDON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 N MILWAUKEE ST UNIT 135
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6652
Mailing Address - Country:US
Mailing Address - Phone:414-839-5597
Mailing Address - Fax:
Practice Address - Street 1:7475 W MAIN ST STE 240
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1552
Practice Address - Country:US
Practice Address - Phone:414-433-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10473-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist