Individual
KAITLYN N IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
12 PORTWALK PL, PORTSMOUTH, NH 03801
(603) 431-4200
(603) 431-4202
Mailing address
12 PORTWALK PL, PORTSMOUTH, NH 03801-4086
(603) 431-4200
(603) 431-4202
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4317
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3116508
—
NH
Enumeration date
08/31/2013
Last updated
09/09/2019
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