Provider Demographics
NPI:1316629413
Name:BRANDL, KIERAN (PTA)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:
Last Name:BRANDL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:
Practice Address - Street 1:315 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:KS
Practice Address - Zip Code:67579-1615
Practice Address - Country:US
Practice Address - Phone:620-204-6116
Practice Address - Fax:620-204-6117
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-04166225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant