Provider Demographics
NPI:1972639979
Name:ROCKWOOD, KERI JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:JO
Last Name:ROCKWOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 LARAWAY RD
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:NY
Mailing Address - Zip Code:13034-3113
Mailing Address - Country:US
Mailing Address - Phone:315-253-7178
Mailing Address - Fax:315-364-8016
Practice Address - Street 1:8842 STATE ROUTE 90 N
Practice Address - Street 2:MANDEL THERAPY GROUP
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081-8717
Practice Address - Country:US
Practice Address - Phone:315-364-7570
Practice Address - Fax:315-364-8016
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021452-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11226391OtherCAQH PROVIDER ID
NYRA4679Medicare ID - Type Unspecified