Provider Demographics
NPI:1689239303
Name:HUGHES, KERRY G (PT)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:G
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ELIZABETH
Other - Last Name:GILSENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E MANANA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-3503
Mailing Address - Country:US
Mailing Address - Phone:575-366-5014
Mailing Address - Fax:
Practice Address - Street 1:100 E MANANA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3503
Practice Address - Country:US
Practice Address - Phone:575-366-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist