Provider Demographics
NPI:1417953910
Name:KERLAN, JOSHUA D (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:D
Last Name:KERLAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 WEST WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-781-1010
Mailing Address - Fax:315-781-1722
Practice Address - Street 1:515 WEST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-781-1010
Practice Address - Fax:315-781-1722
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016517-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00156950OtherPALMETTO GBA
NY200353350OtherUNITED HEALTHCARE
NY5375113OtherAETNA
NY7702607OtherMVP
NY810771OtherEMPIRE PLAN
NYP010016517OtherBLUE CHOICE
NY104539FTOtherPREFERRED CARE
NYP020016517OtherBLUE CROSS/BLUE SHIELD
NYP010016517OtherBLUE CHOICE