Provider Demographics
NPI:1326187063
Name:DUFFY, KERRY SHAW (PT)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:SHAW
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14613 SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-9368
Mailing Address - Country:US
Mailing Address - Phone:704-759-1947
Mailing Address - Fax:
Practice Address - Street 1:1010 EDGEHILL RD N
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1885
Practice Address - Country:US
Practice Address - Phone:704-355-9473
Practice Address - Fax:704-446-6255
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist