Healthcare Provider Details

I. General information

NPI: 1316629413
Provider Name (Legal Business Name): KIERAN BRANDL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W WASHINGTON AVE
STERLING KS
67579-1615
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 620-204-6116
  • Fax: 620-204-6117
Mailing address:
  • Phone: 316-263-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14-04166
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: