Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 1200238 | |
Y | 2251X0800X | Physical Therapist - Orthopedic | 1200238 | TX |
NPI | 1043728389 |
---|---|
Provider Name | Dr. Jennifer Kieschnick |
First Address | Plano, TX 75024-3214 |
Second Address | Plano, TX 75024-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2018 |
Last Update Date | 22/01/2018 |