Provider Demographics
NPI:1497728463
Name:LAMKIN, KERRY (PT)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:
Last Name:LAMKIN
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 1:1709 W PRIEN LAKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8360
Mailing Address - Country:US
Mailing Address - Phone:337-474-5201
Mailing Address - Fax:337-474-5524
Practice Address - Street 1:1709 W PRIEN LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8360
Practice Address - Country:US
Practice Address - Phone:337-474-5201
Practice Address - Fax:337-474-5524
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02049R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C741CQ76Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER