Healthcare Provider Details

I. General information

NPI: 1316026404
Provider Name (Legal Business Name): KEITH WOLSIEFER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VERNEY DR
GREENFIELD NH
03047-5000
US

IV. Provider business mailing address

1 VERNEY DR
GREENFIELD NH
03047-5000
US

V. Phone/Fax

Practice location:
  • Phone: 603-547-3311
  • Fax: 603-547-3232
Mailing address:
  • Phone: 603-547-3311
  • Fax: 603-547-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2867
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: