Kennedy Rose Dierckman, PT, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

Practice address

700 Sun Grove TRL
Georgetown, TX 78628-3737

Phone

(949) 212-3650

NPI assigned

Mar 3, 2025

Last updated

Mar 3, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Human Performance and Rehabilitation Centers, LLC

  • Physical Therapist
  • Columbus, GA
  • NPI 1104415983

  Pediatrics

  Medicare reassignment NPD
• Human Performance and Rehabilitation Centers LLC

  • Durable Medical Equipment & Medical Supplies
  • Columbus, GA
  • NPI 1891583654
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1558168013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 SUN GROVE TRL",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283737",
            "telephone_number": "949-212-3650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 SUN GROVE TRL",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786283737",
            "telephone_number": "949-212-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERCKMAN",
        "first_name": "KENNEDY",
        "middle_name": "ROSE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nisha Desai, O.T.
• Lawrence Devine Jr., PHARMD.
• Jordan Lea Dewberry, RN
• Amanda Lynn Dibenedetto, FNP - C
• Gwendolyn Marie Dicapo, MA, LPC
• Jon Fredrick Dietlein, M.D.
• Dustin P Dinh, DDS
• Discover Chiropractic & Wellness, PLLC
• Rajat Diwan, D.D.S.,
• Bryan Allan Dluski

• Pediatric Physical Therapist in Georgetown, TX
• Providers in Georgetown, TX by specialty
• Pediatric Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.