Provider Demographics
NPI:1922200682
Name:KEARNS, GERRI RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:GERRI
Middle Name:RENEE
Last Name:KEARNS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:GERRI
Other - Middle Name:RENEE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:242 WHITAKER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-2668
Mailing Address - Country:US
Mailing Address - Phone:443-967-0426
Mailing Address - Fax:
Practice Address - Street 1:415 MARKET ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3301
Practice Address - Country:US
Practice Address - Phone:410-939-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant