Provider Demographics
NPI:1629547237
Name:KERN, KEVIN (PTA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KERN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 NC HIGHWAY 18 S
Mailing Address - Street 2:
Mailing Address - City:MORAVIAN FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28654-9516
Mailing Address - Country:US
Mailing Address - Phone:336-937-1503
Mailing Address - Fax:
Practice Address - Street 1:3329 NC HIGHWAY 18 S
Practice Address - Street 2:
Practice Address - City:MORAVIAN FALLS
Practice Address - State:NC
Practice Address - Zip Code:28654-9516
Practice Address - Country:US
Practice Address - Phone:336-937-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2295225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant