Provider Demographics
NPI:1417514464
Name:MCGRATH, KIM ANN (PT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ANN
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:PIERZNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:30 BUXTON FARM RD STE 230
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1206
Mailing Address - Country:US
Mailing Address - Phone:203-212-4191
Mailing Address - Fax:203-212-4191
Practice Address - Street 1:30 BUXTON FARM RD STE 230
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1206
Practice Address - Country:US
Practice Address - Phone:203-212-4191
Practice Address - Fax:203-212-4191
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist