Provider Demographics
NPI:1568990257
Name:KEARNS, IAN TYLER (DPT)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:TYLER
Last Name:KEARNS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536826
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15253-6800
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:123 BATTLEFIELD CROSSING CT
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-5176
Practice Address - Country:US
Practice Address - Phone:706-861-8775
Practice Address - Fax:706-861-8785
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013873225100000X
TN11458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist