Provider Demographics
NPI:1548578024
Name:ROBERTSON, KIERA LINDGREN (ATC)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:LINDGREN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-0344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 OLD MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-3257
Practice Address - Country:US
Practice Address - Phone:845-313-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2010-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0048602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer