Basic Information
| Provider Information | |||||||||
| NPI: | 1881663011 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | BRYAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 ALDAN AVE | ||||||||
| Address2: | |||||||||
| City: | ALDAN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190184204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103942645 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 N MONROE ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190633037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4844440135 | ||||||||
| FaxNumber: | 6105653773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT015036 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | KL1315092 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |