Healthcare Provider Details

I. General information

NPI: 1881249373
Provider Name (Legal Business Name): KAY DIETER OSTERLOH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OLD CHERRY POINT RD
NEW BERN NC
28560-6778
US

IV. Provider business mailing address

2654 DR MARTIN LUTHER KING JR BLVD
NEW BERN NC
28562-4238
US

V. Phone/Fax

Practice location:
  • Phone: 252-637-4730
  • Fax:
Mailing address:
  • Phone: 252-637-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12271687-2401
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP051359T
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12829
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12600
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP048530T
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: