Provider Demographics
NPI:1578251880
Name:NORTHCUTT, KERA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:
Last Name:NORTHCUTT
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W BYRON NELSON BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-3514
Mailing Address - Country:US
Mailing Address - Phone:817-756-5366
Mailing Address - Fax:817-665-3817
Practice Address - Street 1:351 W BYRON NELSON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-3514
Practice Address - Country:US
Practice Address - Phone:817-756-5366
Practice Address - Fax:817-665-3817
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1274418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist