Provider Demographics
NPI:1184997322
Name:KERBY, SHAWN (DPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:KERBY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 SPRINGBORO RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9606
Mailing Address - Country:US
Mailing Address - Phone:513-594-6191
Mailing Address - Fax:
Practice Address - Street 1:7625 PARAGON RD
Practice Address - Street 2:SUITE C
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4067
Practice Address - Country:US
Practice Address - Phone:937-836-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist