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General NPI Number Information
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NPI Number | 1366885261
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Entity Type | Organization
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Legal Business Name | DIANE KLEIST PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 152 COURT ST STE 4
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4453
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Country | US
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Telephone | 603-427-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 152 COURT ST STE 4
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City | PORTSMOUTH
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State | NH
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Zip | 03801-4453
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Country | US
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Telephone | 603-427-5370
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Fax |
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Authorized Official
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Title or Position | OWNER, PT, PRESIDENT
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Name | DIANE KLEIST
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Credential | PT
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Telephone | 603-427-5370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0972
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License Number State | NH
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