Provider Demographics
NPI:1285686535
Name:KERN, KIRK JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:JAMES
Last Name:KERN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-738-0679
Mailing Address - Fax:504-738-2711
Practice Address - Street 1:490 OAK AVE
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123
Practice Address - Country:US
Practice Address - Phone:504-909-2970
Practice Address - Fax:504-738-2711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT754225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H0798OtherBLUE CROSS
H0798OtherBLUE CROSS