Provider Demographics
NPI:1962504449
Name:KERN, VICTORIA T (MPT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:T
Last Name:KERN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057-3905
Mailing Address - Country:US
Mailing Address - Phone:717-439-7955
Mailing Address - Fax:717-948-1628
Practice Address - Street 1:624 COLEBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3905
Practice Address - Country:US
Practice Address - Phone:717-439-7955
Practice Address - Fax:717-948-1628
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007764L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000032100002Medicaid