Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 4683 | NH |
NPI | 1053923417 |
---|---|
Provider Name | Marissa Kibbee |
First Address | Manchester, NH 03104-5401 |
Second Address | Manchester, NH 03104-5401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2020 |
Last Update Date | 18/08/2020 |