McKiernan Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

004917 Issued in CT

Legal business name

MCKIERNAN PHYSICAL THERAPY LLC

Doing business as

Allied Health & Wellness Centers

Practice address

115 Technology Dr
Ste a-200
Trumbull, CT 06611-6337

Phone

(203) 268-5801

Fax

(203) 452-3688

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Edward G McKiernan, RPTNPI 1497866107

Title

Owner

Phone

(203) 268-5801

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• Allied Health & Wellness Centers Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward G McKiernan IV, RPT

  • Physical Therapist
  • Trumbull, CT
  • NPI 1497866107
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359504000000",
    "number": "1841301561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "address_2": "STE A-200",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116337",
            "telephone_number": "203-268-5801",
            "fax_number": "203-452-3688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "address_2": "STE A-200",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116337",
            "telephone_number": "203-268-5801",
            "fax_number": "203-452-3688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKIERNAN PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-01-30",
        "status": "A",
        "authorized_official_last_name": "MCKIERNAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-268-5801",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "004917",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "CT",
            "license": "004917",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "CT",
            "license": "004917",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET PIN",
            "identifier": "2V5288",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "3917515",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PIN",
            "identifier": "080004917CT04",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "3515548",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD PIN",
            "identifier": "A2983697",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allied Health & Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina McDonough, MS, LADC, LPC, NCC
• Janis McDuffie
• William McHenry
• Christie McKenzie, PT
• Rachel Catherine Ameer McKeon, LMFT
• Edward G McKiernan IV, RPT
• Kristensen McKinnie
• Nakida McKnight
• Julie McNeil, RN
• Jacqueline McSally, PA-C

• Physical Therapist in Trumbull, CT
• Providers in Trumbull, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.