MEDICARE: ADAM J KIENERT

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	:	1841781580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM J KIENERT

Provider Business Mailing Address
First Line	:	2105 E ENTERPRISE AVE STE 113
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54913-7862
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 W CHAMPION DR STE 110
Second Line	:
City	:	GRAND CHUTE
State	:	WI
Zip	:	54913-5000
Country	:	US
Telephone Number	:	920-560-1123
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	07/11/2025

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Directions to “ ADAM J KIENERT ” Practice Location

Language	Start Address	Practice Location

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