Provider Demographics
NPI:1750476818
Name:KERNAN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KERNAN PHYSICAL THERAPY
Other - Org Name:KERNAN PHYSICAL THERAPY AT WOODLAWN, AT TIMONIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF THERAPY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-298-0990
Mailing Address - Street 1:PO BOX 64744
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4744
Mailing Address - Country:US
Mailing Address - Phone:410-298-0990
Mailing Address - Fax:410-298-0871
Practice Address - Street 1:3104 LORD BALTIMORE DR
Practice Address - Street 2:EXECUTIVE PARK WEST STE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2898
Practice Address - Country:US
Practice Address - Phone:410-298-0990
Practice Address - Fax:410-298-0871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIPLEY'S PHYSICAL THERAPY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-04
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216633Medicare Oscar/Certification