Provider Demographics
NPI:1376886432
Name:NITZSCHKE, ROBERT DAVIS (LMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVIS
Last Name:NITZSCHKE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 COUNTRY CLUB DRIVE
Mailing Address - Street 2:APT 16
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-8771
Mailing Address - Country:US
Mailing Address - Phone:603-620-0148
Mailing Address - Fax:
Practice Address - Street 1:24 COUNTRY CLUB DR
Practice Address - Street 2:APT. 16
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-8792
Practice Address - Country:US
Practice Address - Phone:603-620-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1472M173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist