Provider Demographics
NPI:1215638226
Name:KIENLE, THERESA JOYCE (PT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:JOYCE
Last Name:KIENLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 KIRKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6814
Mailing Address - Country:US
Mailing Address - Phone:919-280-5260
Mailing Address - Fax:
Practice Address - Street 1:801 DIXIE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-4156
Practice Address - Country:US
Practice Address - Phone:919-828-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP1745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist