Provider Demographics
NPI:1154767598
Name:TILLER, KERRI A (DPT/OCS)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:TILLER
Suffix:
Gender:F
Credentials:DPT/OCS
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:A
Other - Last Name:GHERARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1230 TENDERFOOT HILL RD STE 155
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7346
Mailing Address - Country:US
Mailing Address - Phone:719-527-3383
Mailing Address - Fax:719-527-2688
Practice Address - Street 1:1230 TENDERFOOT HILL RD STE 155
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-7346
Practice Address - Country:US
Practice Address - Phone:719-527-3383
Practice Address - Fax:719-527-2688
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0012153225100000X
CO121532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO809211Medicare PIN