Healthcare Provider Details

I. General information

NPI: 1972516052
Provider Name (Legal Business Name): KIMBERLY L. O'LEARY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY L. FOTTER P.T.

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PILLSBURY STREET
CONCORD NH
03301
US

IV. Provider business mailing address

8 CORPORATE DRIVE
BELMONT NH
03220
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-3397
  • Fax: 903-524-9364
Mailing address:
  • Phone: 603-524-3397
  • Fax: 603-524-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1337
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: