Provider Demographics
NPI:1336590561
Name:KERSHNER, ROBERT LOUIS (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LOUIS
Last Name:KERSHNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6615
Mailing Address - Country:US
Mailing Address - Phone:303-859-2742
Mailing Address - Fax:
Practice Address - Street 1:4410 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6615
Practice Address - Country:US
Practice Address - Phone:303-859-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist