Provider Demographics
NPI:1497337760
Name:KIERNAN, JAMES PETER (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PETER
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 THEODORE FREMD AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1410
Mailing Address - Country:US
Mailing Address - Phone:914-921-6061
Mailing Address - Fax:
Practice Address - Street 1:411 THEODORE FREMD AVE
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-1410
Practice Address - Country:US
Practice Address - Phone:914-921-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist