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Individual
MARK KEVERN
Active
Individual
MARK KEVERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9721
NC
2251X0800X
Orthopedic Physical Therapist
9721
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4990
LIC
SC
01
—
9721
PT LICENSE
NC
Enumeration date
09/14/2006
Last updated
09/25/2018
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