Provider Demographics
NPI:1770679011
Name:KERKELA, KRISTY RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:RENEE
Last Name:KERKELA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT, SCS
Mailing Address - Street 1:463 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9512
Mailing Address - Country:US
Mailing Address - Phone:906-458-0421
Mailing Address - Fax:
Practice Address - Street 1:820 CARP RIVER LN
Practice Address - Street 2:SUITE 2
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3187
Practice Address - Country:US
Practice Address - Phone:906-204-7400
Practice Address - Fax:906-204-7402
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist