Provider Demographics
NPI:1881663011
Name:KLEIN, DOUGLAS BRYAN (PT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRYAN
Last Name:KLEIN
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 1:412 ALDAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALDAN
Mailing Address - State:PA
Mailing Address - Zip Code:19018-4204
Mailing Address - Country:US
Mailing Address - Phone:610-394-2645
Mailing Address - Fax:
Practice Address - Street 1:101 N MONROE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3037
Practice Address - Country:US
Practice Address - Phone:484-444-0135
Practice Address - Fax:610-565-3773
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKL1315092OtherHIGHMARK BLUE SHIELD
PAKL1315092OtherHIGHMARK BLUE SHIELD