Provider Demographics
NPI:1992867105
Name:KERBO, LYNDA SIMS (PT)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:SIMS
Last Name:KERBO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LYNDA
Other - Middle Name:LEE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8235 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080
Mailing Address - Country:US
Mailing Address - Phone:615-876-4372
Mailing Address - Fax:
Practice Address - Street 1:608 8TH AVE E
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172
Practice Address - Country:US
Practice Address - Phone:615-384-8453
Practice Address - Fax:615-384-9350
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist