Provider Demographics
NPI:1720154065
Name:VERNOLD, KRISTOPHER DREW (MPT)
Entity Type:Individual
Prefix:MR
First Name:KRISTOPHER
Middle Name:DREW
Last Name:VERNOLD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GEER RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-3400
Mailing Address - Country:US
Mailing Address - Phone:518-761-0850
Mailing Address - Fax:518-745-1351
Practice Address - Street 1:13 BAYWOOD DR
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5822
Practice Address - Country:US
Practice Address - Phone:518-761-0850
Practice Address - Fax:518-745-1351
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022083-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000403950001OtherBLUE SHIELD
NY826692OtherACN
NY000403950001OtherBLUE SHIELD