Provider Demographics
NPI:1205310232
Name:RYNDAK, KIERSTEN ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:KIERSTEN
Middle Name:ANNE
Last Name:RYNDAK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:ANNE
Other - Last Name:MASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4871 LOWER MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-9742
Mailing Address - Country:US
Mailing Address - Phone:716-438-0091
Mailing Address - Fax:
Practice Address - Street 1:6000 BROCKTON DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9273
Practice Address - Country:US
Practice Address - Phone:716-201-1049
Practice Address - Fax:716-201-1156
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014136-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist