Individual
JOHN DAVID KIESEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1312 W ARCH HAVEN AVE STE E, BLOOMINGTON, IN 47403-2088
(812) 336-8406
(812) 336-8342
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010388A
IN
225100000X
Physical Therapist
PT60132052
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225233307
—
WA
05
—
500669289
—
OR
01
—
P01062853
RR MEDICARE
WA
Enumeration date
06/18/2007
Last updated
10/27/2016
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