Provider Demographics
NPI:1740384254
Name:MORRIS, KERRI (PT)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOLLYWOOD BLVD SW STE 7
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4893
Mailing Address - Country:US
Mailing Address - Phone:850-226-7411
Mailing Address - Fax:850-226-7496
Practice Address - Street 1:24 HOLLYWOOD BLVD SW STE 7
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4893
Practice Address - Country:US
Practice Address - Phone:850-226-7411
Practice Address - Fax:850-226-7496
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1942174400000X
FLPT352022251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL792357Medicaid