Provider Demographics
NPI:1710102942
Name:KERWIN, JOANNE PATRICIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:PATRICIA
Last Name:KERWIN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 380706
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-0706
Mailing Address - Country:US
Mailing Address - Phone:617-876-2435
Mailing Address - Fax:781-860-5221
Practice Address - Street 1:40 EARL ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4244
Practice Address - Country:US
Practice Address - Phone:617-876-2435
Practice Address - Fax:781-860-5221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY65214Medicare ID - Type UnspecifiedPHYSICAL THERAPIST