Provider Demographics
NPI:1295265742
Name:KERBY, LEVI ALAN (PT DPT)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:ALAN
Last Name:KERBY
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:016-484-8784
Practice Address - Street 1:905 OLD WINSTON RD STE B
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6640
Practice Address - Country:US
Practice Address - Phone:336-992-2787
Practice Address - Fax:336-993-9943
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016982225100000X
NCP17885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty