Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4000 | NC |
N | 2251H1200X | Hand | 1021100288 | NC |
NPI | 1518948546 |
---|---|
Provider Name | Maxine B Kleinhans |
First Address | Ooltewah, TN 37363-6511 |
Second Address | Greensboro, NC 27401-1038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 16/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4968K | BC/BS OF NC (01) | NC |
63559 | MEDCOST (01) | NC |
650013005 | MEDICARE RAILROAD (01) | NC |
7201114 | (05) | NC |