Provider Demographics
NPI:1679177596
Name:FOSSELLA, KIERSTYN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIERSTYN
Middle Name:
Last Name:FOSSELLA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIERSTYN
Other - Middle Name:
Other - Last Name:PIERONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:981 US HIGHWAY 22 FL 2
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2946
Mailing Address - Country:US
Mailing Address - Phone:201-801-7141
Mailing Address - Fax:
Practice Address - Street 1:1351 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2049
Practice Address - Country:US
Practice Address - Phone:718-390-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist