Basic Information
| Provider Information | |||||||||
| NPI: | 1427532233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNISELY | ||||||||
| FirstName: | SAVANNAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 193 CRESCENT WAY | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038013413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844594553 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 RYE ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038016829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036102200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2018 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4424 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 14338293 | 01 | CAQH | OTHER | 4424 | 01 | NH | PHYSICAL THERAPY STATE LICENSE | OTHER | 1427532233 | 01 | NPI | OTHER |