Individual
KERRY REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1311 GAUSE BLVD, SLIDELL, LA 70458-3015
(985) 649-6577
Mailing address
2613 LAKESHORE DR, MANDEVILLE, LA 70448-5628
(985) 626-3286
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01466R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4B940BD21
MEDICARE ID
LA
Enumeration date
06/11/2006
Last updated
03/12/2008
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