MEDICARE: DR. JAMES PETER KIERNAN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	047164	NY

General Provider Information

NPI Number	:	1497337760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES PETER KIERNAN DPT

Provider Business Mailing Address
First Line	:	411 THEODORE FREMD AVE
Second Line	:
City	:	RYE
State	:	NY
Zip	:	10580-1410
Country	:	US
Telephone Number	:	914-921-6061
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 THEODORE FREMD AVE
Second Line	:
City	:	RYE
State	:	NY
Zip	:	10580-1410
Country	:	US
Telephone Number	:	914-921-6061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2021
Last Update Date	:	04/26/2021

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