Provider Demographics
NPI:1134230378
Name:KIEVNING, WILLIAM BARRY (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BARRY
Last Name:KIEVNING
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 BANCROFT RD
Mailing Address - Street 2:#131
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1531
Mailing Address - Country:US
Mailing Address - Phone:510-703-5555
Mailing Address - Fax:925-822-3032
Practice Address - Street 1:3390 MT. DIABLO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:925-284-6150
Practice Address - Fax:925-284-6155
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ174312Medicare ID - Type Unspecified