Healthcare Provider Details

I. General information

NPI: 1043728389
Provider Name (Legal Business Name): JENNIFER KIESCHNICK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 PRESTON RD
PLANO TX
75024-3214
US

IV. Provider business mailing address

7601 PRESTON RD
PLANO TX
75024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 469-303-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1200238
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1200238
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: