Provider Demographics
NPI:1982866323
Name:WALLS, KERRI RAYE (PT, CLT, LANA)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:RAYE
Last Name:WALLS
Suffix:
Gender:F
Credentials:PT, CLT, LANA
Other - Prefix:MISS
Other - First Name:KERRI
Other - Middle Name:RAYE
Other - Last Name:ELPERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:637 S STATE ROAD 135
Mailing Address - Street 2:STE C
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1443
Mailing Address - Country:US
Mailing Address - Phone:317-865-1110
Mailing Address - Fax:317-865-0221
Practice Address - Street 1:637 S STATE ROAD 135
Practice Address - Street 2:STE C
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1443
Practice Address - Country:US
Practice Address - Phone:317-865-1110
Practice Address - Fax:317-865-0221
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006215A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist