Provider Demographics
NPI:1740568617
Name:KERN, BRYCE THOMAS (ATC)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:THOMAS
Last Name:KERN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-8869
Mailing Address - Country:US
Mailing Address - Phone:715-370-6000
Mailing Address - Fax:
Practice Address - Street 1:327 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4285
Practice Address - Country:US
Practice Address - Phone:715-845-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer