MEDICARE: JEFF KIERMAS PT

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

General Provider Information

NPI Number	:	1689421323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF KIERMAS PT

Provider Business Mailing Address
First Line	:	700 E OAK ST
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6176
Country	:	US
Telephone Number	:	847-766-0011
Fax Number	:	847-999-6722

Provider Business Practice Location Address
First Line	:	700 E OAK ST
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6176
Country	:	US
Telephone Number	:	847-766-0011
Fax Number	:	847-999-6722

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

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	05/01/2024

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