Basic Information
| Provider Information | |||||||||
| NPI: | 1922474634 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIYOTA | ||||||||
| FirstName: | DUANE | ||||||||
| MiddleName: | T | ||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GORHAM | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040381340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078395860 | ||||||||
| FaxNumber: | 2078392499 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 OCEAN ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041063600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077998226 | ||||||||
| FaxNumber: | 2077999340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 08/18/2015 | ||||||||
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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 | PT4511 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.