Individual
KELLY W KERSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
6101 NORTHWEST BLVD, DAVENPORT, IA 52806-1861
(563) 449-7004
Mailing address
850 43RD AVE STE 100, MOLINE, IL 61265-8401
(309) 743-2070
(309) 743-2073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004560
IA
225100000X
Physical Therapist
070-014938
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004560
IOWA LICENSE NUMBER
IA
01
—
070-014938
ILLINOIS PT LICENSE NO.
IL
Enumeration date
05/12/2006
Last updated
03/24/2021
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