Provider Demographics
NPI:1417141821
Name:NIESZ, KATHLEEN CONNOLLY (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CONNOLLY
Last Name:NIESZ
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 1:1020 GALLOPING HILL RD
Mailing Address - Street 2:ST BARNABAS REHABILITATION AFFILIATES
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083
Mailing Address - Country:US
Mailing Address - Phone:908-851-8816
Mailing Address - Fax:908-851-2327
Practice Address - Street 1:234 CHESTNUT ST
Practice Address - Street 2:CORNELL HALL CONVELISCENT CENTER
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083
Practice Address - Country:US
Practice Address - Phone:908-624-2328
Practice Address - Fax:908-687-1417
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00179100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist