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Individual
KERI LYN GUSTAVSEN
Active
Individual
KERI LYN GUSTAVSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1161526
TX
2251X0800X
Orthopedic Physical Therapist
1161526
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
825T48
BCBS
TX
01
—
P00852663
MEDICARE RAILROAD
—
Enumeration date
07/06/2006
Last updated
11/04/2010
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