Provider Demographics
NPI:1477312155
Name:WOOTEN, KERRY BROOKE (MS, ACSM-CEP, CDCES)
Entity Type:Individual
Prefix:MS
First Name:KERRY
Middle Name:BROOKE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MS, ACSM-CEP, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5246
Mailing Address - Country:US
Mailing Address - Phone:774-770-5297
Mailing Address - Fax:
Practice Address - Street 1:235 HANOVER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5246
Practice Address - Country:US
Practice Address - Phone:774-770-5297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist