Provider Demographics
NPI:1457505190
Name:KEHM, AUTUMN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:
Last Name:KEHM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 HUFFMAN RD STE 16
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3561
Mailing Address - Country:US
Mailing Address - Phone:907-770-9111
Mailing Address - Fax:907-770-9110
Practice Address - Street 1:1120 HUFFMAN RD STE 16
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-770-9111
Practice Address - Fax:907-770-9110
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8258225100000X
AKPHYP2185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist