Basic Information
| Provider Information | |||||||||
| NPI: | 1184997322 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERBY | ||||||||
| FirstName: | SHAWN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3417 SPRINGBORO RD | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450369606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135946191 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7625 PARAGON RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9378365143 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2012 | ||||||||
| LastUpdateDate: | 02/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 012084 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.