Provider Demographics
NPI:1871185702
Name:KOEHLER, KIERAN ALYSSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIERAN
Middle Name:ALYSSA
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIERAN
Other - Middle Name:ALYSSA
Other - Last Name:STOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4849 STEPHANIE PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-3522
Mailing Address - Country:US
Mailing Address - Phone:267-885-9527
Mailing Address - Fax:
Practice Address - Street 1:713 MISSION AVE STE B
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2852
Practice Address - Country:US
Practice Address - Phone:760-450-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214271225100000X
CA299212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist