MEDICARE: LIVING WELL PHYSICAL THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	2775	NH

General Provider Information

NPI Number	:	1285934380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVING WELL PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	184 RAYMOND RD
Second Line	:
City	:	CHESTER
State	:	NH
Zip	:	03036-4127
Country	:	US
Telephone Number	:	603-887-7800
Fax Number	:	603-887-7801

Provider Business Practice Location Address
First Line	:	184 RAYMOND RD
Second Line	:
City	:	CHESTER
State	:	NH
Zip	:	03036-4127
Country	:	US
Telephone Number	:	603-887-7800
Fax Number	:	603-887-7801

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	JULIE A KINNEY
Credential	:	DPT
Telephone Number	:	603-401-3044

Provider Enumeration Date	:	10/24/2010
Last Update Date	:	08/20/2012

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