Organization
TERRY KERN PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY KERN P.T. (OWNER)
(505) 761-0016
Entity
Organization
Contact information
Practice address
5971 JEFFERSON ST NE, STE 102, ALBUQUERQUE, NM 87109-3413
(505) 761-0016
(505) 761-0025
Mailing address
5971 JEFFERSON ST NE, STE 102, ALBUQUERQUE, NM 87109-3413
(505) 761-0016
(505) 761-0025
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
515
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174400000X
—
NM
01
—
800521050
MEDICARE GROUP
NM
Enumeration date
04/09/2008
Last updated
04/25/2012
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