Provider Demographics
NPI:1225218720
Name:KIRRANE, JEANNETTE ALISE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:ALISE
Last Name:KIRRANE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 CAMINO RAMON
Mailing Address - Street 2:STE B
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-830-5133
Mailing Address - Fax:925-830-5135
Practice Address - Street 1:2208 CAMINO RAMON
Practice Address - Street 2:STE B
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-830-5133
Practice Address - Fax:925-830-5135
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294256225100000X
CT006516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080006516OtherANTHEM BC
CT1225218720Medicaid
CT1225218720Medicaid