Basic Information
| Provider Information | |||||||||
| NPI: | 1750857488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEES | ||||||||
| FirstName: | CARRIE | ||||||||
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| OtherLastName: | TINNEY | ||||||||
| OtherFirstName: | CARRIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 FLORAL VALE BLVD | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158600100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 FLORAL VALE BLVD | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158600100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2018 | ||||||||
| LastUpdateDate: | 10/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.