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General NPI Number Information
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NPI Number | 1720154065
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Entity Type | Individual
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Provider Name | KRISTOPHER DREW VERNOLD MPT
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13 BAYWOOD DR
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City | QUEENSBURY
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State | NY
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Zip | 12804-5822
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Country | US
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Telephone | 518-761-0850
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Fax | 518-745-1351
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Provider Business Mailing Address
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Address Line | 43 GEER RD
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City | HUDSON FALLS
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State | NY
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Zip | 12839-3400
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Country | US
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Telephone | 518-761-0850
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Fax | 518-745-1351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 022083-1
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License Number State | NY
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