Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1108496 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1108496 | TX |
NPI | 1083768857 |
---|---|
Provider Name | Carolyn Kerby |
First Address | Austin, TX 78704-3422 |
Second Address | Austin, TX 78705-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |