Provider Demographics
NPI:1447843123
Name:TRICE, KERRI LYNN (PTA)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:LYNN
Last Name:TRICE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 SW NORTH WAKEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-5444
Mailing Address - Country:US
Mailing Address - Phone:772-828-1470
Mailing Address - Fax:
Practice Address - Street 1:257 SW NORTH WAKEFIELD CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-5444
Practice Address - Country:US
Practice Address - Phone:772-828-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25856225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant