Provider Demographics
NPI:1285301218
Name:GOLDEN, KERRY ANN (PT)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:GOLDEN
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:PO BOX 26444
Mailing Address - Street 2:
Mailing Address - City:MUNDS PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:86017-6444
Mailing Address - Country:US
Mailing Address - Phone:520-981-0269
Mailing Address - Fax:
Practice Address - Street 1:1485 N TURQUOISE DR STE 220
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2000
Practice Address - Country:US
Practice Address - Phone:928-774-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ002572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist