Provider Demographics
NPI:1669459483
Name:KERRY, KURT ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:ROBERT
Last Name:KERRY
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 1:94 JYLHA RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9570
Mailing Address - Country:US
Mailing Address - Phone:906-360-0957
Mailing Address - Fax:906-225-5990
Practice Address - Street 1:700 W WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4163
Practice Address - Country:US
Practice Address - Phone:906-225-5585
Practice Address - Fax:906-225-5990
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65-0-E2-1063-0OtherBLUE CROSS/BLUE SHIELD
MI65-0-E2-1063-0OtherBLUE CROSS/BLUE SHIELD