Provider Demographics
NPI:1801495676
Name:KERN, AUBREY MARIE
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:MARIE
Last Name:KERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 ARIADNE TRL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4120
Mailing Address - Country:US
Mailing Address - Phone:330-703-9745
Mailing Address - Fax:
Practice Address - Street 1:105 SUGAR CAMP CIR STE 221
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45409-1979
Practice Address - Country:US
Practice Address - Phone:937-227-3174
Practice Address - Fax:937-227-3325
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist