Basic Information
| Provider Information | |||||||||
| NPI: | 1487026092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERSHAW | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | D.P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5285 | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688025285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083820344 | ||||||||
| FaxNumber: | 3083823241 | ||||||||
| Practice Location | |||||||||
| Address1: | 3219 CENTRAL AVE | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | KEARNEY | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688472949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3088657182 | ||||||||
| FaxNumber: | 3088652881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2015 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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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 | 3487 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.