Provider Demographics
NPI:1134553407
Name:KERRI A. KRIEGER, DPT, PA
Entity type:Organization
Organization Name:KERRI A. KRIEGER, DPT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:772-485-6100
Mailing Address - Street 1:1250 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5385
Mailing Address - Country:US
Mailing Address - Phone:772-485-6100
Mailing Address - Fax:
Practice Address - Street 1:1250 SE PORT ST LUCIE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5385
Practice Address - Country:US
Practice Address - Phone:772-485-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy