Provider Demographics
NPI:1578679619
Name:KERR, DANIELLE M (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:KERR
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 1:10833 LECONTE AVE
Mailing Address - Street 2:ATTN: REHAB SERVICES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-825-5650
Mailing Address - Fax:
Practice Address - Street 1:10833 LECONTE AVE
Practice Address - Street 2:ATTN: REHAB SERVICES
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS7447838OtherAETNA
WA2257KEOtherBLUE SHIELD
WA0039585OtherL&I
WA2257KEOtherBLUE SHIELD