Provider Demographics
NPI:1154440808
Name:JUNIO, CLETUS DIAZ (PT)
Entity Type:Individual
Prefix:
First Name:CLETUS
Middle Name:DIAZ
Last Name:JUNIO
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 1:421 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3047
Mailing Address - Country:US
Mailing Address - Phone:603-528-1445
Mailing Address - Fax:
Practice Address - Street 1:20 MAITLAND ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3534
Practice Address - Country:US
Practice Address - Phone:603-224-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist