Provider Demographics
NPI:1093827388
Name:KIECKE, DENNIS (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:KIECKE
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:PO BOX 1401
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22503 KATY FWY
Practice Address - Street 2:1
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1512
Practice Address - Country:US
Practice Address - Phone:281-693-0300
Practice Address - Fax:281-693-0301
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1028918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist