Provider Demographics
NPI:1679816193
Name:DARASKAVICH, KERRY DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:DAWN
Last Name:DARASKAVICH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8474
Mailing Address - Country:US
Mailing Address - Phone:910-622-6006
Mailing Address - Fax:910-300-6425
Practice Address - Street 1:311 SOUTH CAMPELL STREET
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425
Practice Address - Country:US
Practice Address - Phone:910-300-6424
Practice Address - Fax:910-300-6425
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist