MEDICARE: KATHLEEN NGOC LE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4565	NH

General Provider Information

NPI Number	:	1851949838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN NGOC LE PT, DPT

Provider Business Mailing Address
First Line	:	53 NATHANIEL DR
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-6003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 PORTSMOUTH AVE
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2264
Country	:	US
Telephone Number	:	603-400-0711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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