Provider Demographics
NPI:1770577819
Name:LIERMANN, KELLY (MSED, ATC, PES)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:LIERMANN
Suffix:
Gender:F
Credentials:MSED, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 WHITFORD CIR
Mailing Address - Street 2:APT 801
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 WESTHAMPTON WAY
Practice Address - Street 2:163 ROBINS CENTER
Practice Address - City:UNIVERSITY OF RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23173-0001
Practice Address - Country:US
Practice Address - Phone:804-289-8001
Practice Address - Fax:804-289-8791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA012600079002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer