Provider Demographics
NPI:1427532233
Name:KNISELY, SAVANNAH (DPT)
Entity type:Individual
Prefix:MS
First Name:SAVANNAH
Middle Name:
Last Name:KNISELY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CRESCENT WAY
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3413
Mailing Address - Country:US
Mailing Address - Phone:484-459-4553
Mailing Address - Fax:
Practice Address - Street 1:15 RYE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6829
Practice Address - Country:US
Practice Address - Phone:603-610-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14338293OtherCAQH
NH4424OtherPHYSICAL THERAPY STATE LICENSE
1427532233OtherNPI