Provider Demographics
NPI:1346409372
Name:KIERAN J TRAYNOR PT PC
Entity Type:Organization
Organization Name:KIERAN J TRAYNOR PT PC
Other - Org Name:SUMMIT SPORTS & SPINAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIERAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TRAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT OCS MTC
Authorized Official - Phone:914-834-5490
Mailing Address - Street 1:1420 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3922
Mailing Address - Country:US
Mailing Address - Phone:914-834-5490
Mailing Address - Fax:914-834-5402
Practice Address - Street 1:1420 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3922
Practice Address - Country:US
Practice Address - Phone:914-834-5490
Practice Address - Fax:914-834-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty