Provider Demographics
NPI:1356645493
Name:KERR, KELLY MAUREEN (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MAUREEN
Last Name:KERR
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 1:1840 SAN MIGUEL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8603
Mailing Address - Country:US
Mailing Address - Phone:650-685-4800
Mailing Address - Fax:650-685-4802
Practice Address - Street 1:1840 SAN MIGUEL DR
Practice Address - Street 2:STE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8603
Practice Address - Country:US
Practice Address - Phone:650-685-4800
Practice Address - Fax:650-685-4802
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist