Provider Demographics
NPI:1639542723
Name:KERR, SONDRA KRISTEN (PT DPT)
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:KRISTEN
Last Name:KERR
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:SONDRA
Other - Middle Name:
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1338 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2127
Practice Address - Country:US
Practice Address - Phone:760-789-1400
Practice Address - Fax:760-789-1401
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA177783Medicare PIN
CACA177784Medicare PIN
CACB245911Medicare PIN
CACA177785Medicare PIN