Healthcare Provider Details

I. General information

NPI: 1639476450
Provider Name (Legal Business Name): JENNY MARIE KIRSTEIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 1ST AVE NE
CEDAR RAPIDS IA
52402-5010
US

IV. Provider business mailing address

1330 1ST AVE
CEDAR RAPIDS IA
52402
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-1569
  • Fax: 319-399-2037
Mailing address:
  • Phone: 319-398-1569
  • Fax: 319-399-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004683
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: