Provider Demographics
NPI:1487612487
Name:PEDERSEN, KAI H (PT)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:H
Last Name:PEDERSEN
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 1:600 E PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1622
Mailing Address - Country:US
Mailing Address - Phone:610-451-5982
Mailing Address - Fax:
Practice Address - Street 1:600 E PENN AVE
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-1622
Practice Address - Country:US
Practice Address - Phone:610-451-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010933L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064555EJAMedicare ID - Type Unspecified
PAP72976Medicare UPIN