Provider Demographics
NPI:1871677807
Name:HALCOMB, KERRY ALLEN (PT)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:ALLEN
Last Name:HALCOMB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20612 N CAVE CREEK RD # F151
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4440
Mailing Address - Country:US
Mailing Address - Phone:602-237-5047
Mailing Address - Fax:602-237-5522
Practice Address - Street 1:20612 N CAVE CREEK RD # F151
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4440
Practice Address - Country:US
Practice Address - Phone:602-237-5047
Practice Address - Fax:602-237-5522
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist