Individual
JENNIFER LYN KANIESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10301 GOLF COURSE RD NW, ALBUQUERQUE, NM 87114-5380
(928) 460-3599
Mailing address
8201 GOLF COURSE RD NW # D3-178, ALBUQUERQUE, NM 87120-5842
(928) 460-3599
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3863
NM
225100000X
Physical Therapist
4499
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3863
NEW MEXICO BOARD OF PHYSICAL THERAPY
NM
01
—
4499
OREGON LICENSE
OR
05
—
PENDING
—
OR
Enumeration date
06/02/2009
Last updated
07/09/2020
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