Provider Demographics
NPI:1598741001
Name:KERWIN, ROBERT BRADLEY (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:KERWIN
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 1:8923 TANAGER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7345
Mailing Address - Country:US
Mailing Address - Phone:713-621-2486
Mailing Address - Fax:713-621-2491
Practice Address - Street 1:8923 TANAGER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7345
Practice Address - Country:US
Practice Address - Phone:713-621-2486
Practice Address - Fax:713-621-2491
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1626OtherBLUECROSSBLUESHEILD#
TX8B4419Medicare ID - Type Unspecified