Provider Demographics
NPI:1760472278
Name:HOUCK, KERIANNE (PT)
Entity type:Individual
Prefix:
First Name:KERIANNE
Middle Name:
Last Name:HOUCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3218
Mailing Address - Country:US
Mailing Address - Phone:330-297-9020
Mailing Address - Fax:330-297-9095
Practice Address - Street 1:1850 STATE ROUTE 59
Practice Address - Street 2:STE B
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4174
Practice Address - Country:US
Practice Address - Phone:330-676-9544
Practice Address - Fax:330-676-9547
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6661OtherOT PT ATC BOARD