Provider Demographics
NPI:1154406502
Name:KLETT, W. ERIC (PT)
Entity type:Individual
Prefix:
First Name:W.
Middle Name:ERIC
Last Name:KLETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEGEND LANE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9424
Mailing Address - Country:US
Mailing Address - Phone:717-620-7100
Mailing Address - Fax:717-620-7102
Practice Address - Street 1:1 LEGEND LANE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9424
Practice Address - Country:US
Practice Address - Phone:717-620-7100
Practice Address - Fax:717-620-7102
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013116L2251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA045508D1XMedicare PIN