Provider Demographics
NPI:1639498124
Name:KERBO, STANLEY LOYD (PT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:LOYD
Last Name:KERBO
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 1:1451 ELM HILL PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4523
Mailing Address - Country:US
Mailing Address - Phone:615-399-2220
Mailing Address - Fax:615-399-4002
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-412-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-23
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist