Provider Demographics
NPI:1093013609
Name:TROMBLEY, KEVIN D (PTA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HEARTWOOD LN
Mailing Address - Street 2:APT 4
Mailing Address - City:PENACOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03303-3479
Mailing Address - Country:US
Mailing Address - Phone:603-858-1498
Mailing Address - Fax:
Practice Address - Street 1:191 HACKETT HILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-8993
Practice Address - Country:US
Practice Address - Phone:603-668-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0979225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant