Provider Demographics
NPI:1376510040
Name:KEARSLEY, THOMAS D (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:D
Last Name:KEARSLEY
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 1:25 N BOSTON AVE
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-3534
Mailing Address - Country:US
Mailing Address - Phone:609-442-1667
Mailing Address - Fax:
Practice Address - Street 1:6307 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:VENTNOR
Practice Address - State:NJ
Practice Address - Zip Code:08406-2273
Practice Address - Country:US
Practice Address - Phone:609-822-2628
Practice Address - Fax:609-822-5173
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00985400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist