Provider Demographics
NPI:1194279406
Name:WAEGELEIN, KERRI ANN (DPT)
Entity type:Individual
Prefix:DR
First Name:KERRI
Middle Name:ANN
Last Name:WAEGELEIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COOL BLOW ST APT 337
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-4275
Mailing Address - Country:US
Mailing Address - Phone:845-242-8732
Mailing Address - Fax:
Practice Address - Street 1:1909 N HIGHWAY 17
Practice Address - Street 2:STE Q
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7459
Practice Address - Country:US
Practice Address - Phone:843-416-9026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist