Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 3264 | NM |
NPI | 1386965671 |
---|---|
Provider Name | Mr. Stephen John Kerr |
First Address | Rio Rancho, NM 87144-2627 |
Second Address | Albuquerque, NM 87109-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2010 |
Last Update Date | 21/06/2010 |