Provider Demographics
NPI:1811089337
Name:SHPUR, KERRI L (PT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:L
Last Name:SHPUR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4984 BIG CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-3819
Mailing Address - Country:US
Mailing Address - Phone:518-321-2898
Mailing Address - Fax:
Practice Address - Street 1:4725 BELLWETHER LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-2980
Practice Address - Country:US
Practice Address - Phone:352-430-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0183751225100000X
FL34488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q03D71OtherBLUE CROSS
000404983001OtherBLUE SHIELD
RA0812Medicare ID - Type Unspecified
Q08717Medicare UPIN