Provider Demographics
NPI:1447329677
Name:KIENINGER, MEGHAN E (PT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:E
Last Name:KIENINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2434
Mailing Address - Country:US
Mailing Address - Phone:770-889-2163
Mailing Address - Fax:770-889-4385
Practice Address - Street 1:100 MOUNTAIN VIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2434
Practice Address - Country:US
Practice Address - Phone:770-889-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT008890OtherSTATE LISC NUMBER