Provider Demographics
NPI:1972335461
Name:GIAMMICHELE, KIERAN WILLIAM (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:WILLIAM
Last Name:GIAMMICHELE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 CAMINO DOS RIOS STE 406
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1156
Mailing Address - Country:US
Mailing Address - Phone:805-375-1461
Mailing Address - Fax:
Practice Address - Street 1:2814 CAMINO DOS RIOS STE 406
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1156
Practice Address - Country:US
Practice Address - Phone:805-375-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist