Provider Demographics
NPI:1770270233
Name:KERSTETTER, ERIC WILLIAM (DPT)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:KERSTETTER
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 1:3146 NE NEHALEM AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9032
Mailing Address - Country:US
Mailing Address - Phone:570-417-4983
Mailing Address - Fax:
Practice Address - Street 1:947 GEARY ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-4904
Practice Address - Country:US
Practice Address - Phone:541-704-7770
Practice Address - Fax:541-704-7773
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist