Provider Demographics
NPI:1184233231
Name:PRINCE, KERI ALEXA (DPT)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:ALEXA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WINDWARD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2174
Mailing Address - Country:US
Mailing Address - Phone:540-949-5383
Mailing Address - Fax:540-949-5493
Practice Address - Street 1:32 WINDWARD DR STE 110
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2174
Practice Address - Country:US
Practice Address - Phone:540-949-5383
Practice Address - Fax:540-949-5493
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPT63706225100000X, 2251X0800X
VACP026250T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPT63706OtherPT LICENSE