Provider Demographics
NPI:1538208053
Name:KIRNER, EVELYN B (RPT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:B
Last Name:KIRNER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NEWTOWN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4114
Mailing Address - Country:US
Mailing Address - Phone:203-744-4343
Mailing Address - Fax:203-744-8055
Practice Address - Street 1:105 NEWTOWN RD
Practice Address - Street 2:SUITE B
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4114
Practice Address - Country:US
Practice Address - Phone:203-744-4343
Practice Address - Fax:203-744-8055
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist