Provider Demographics
NPI:1588729370
Name:KIERNAN, ALYSON (PT, MS)
Entity type:Individual
Prefix:MS
First Name:ALYSON
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N MATANZAS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:928-300-0296
Mailing Address - Fax:928-634-1906
Practice Address - Street 1:1329 E HWY 89A
Practice Address - Street 2:STE. D
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4506
Practice Address - Country:US
Practice Address - Phone:928-634-1900
Practice Address - Fax:928-634-1906
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79442Medicare ID - Type Unspecified