Provider Demographics
NPI:1497040992
Name:KERSCHEN, KASSANDRA L (PT)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:L
Last Name:KERSCHEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 S 133RD PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-5905
Mailing Address - Country:US
Mailing Address - Phone:402-330-8433
Mailing Address - Fax:402-330-8616
Practice Address - Street 1:1226 N WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3064
Practice Address - Country:US
Practice Address - Phone:402-593-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2991225100000X
IA004782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist