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NPI Code Detail

MEDICARE: BRENT B MESERVE PT, DPT

MEDICARE: BRENT B MESERVE PT, DPT
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
1225100000XPhysical Therapist3152NH

General Provider Information

NPI Number : 1477834018
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT B MESERVE PT, DPT
Provider Business Mailing Address
First Line : PO BOX 585
Second Line :
City : PLYMOUTH
State : NH
Zip : 03264-0585
Country : US
Telephone Number : 603-536-4991
Fax Number :
Provider Business Practice Location Address
First Line : 790 LAKE ST
Second Line :
City : BRISTOL
State : NH
Zip : 03222-4548
Country : US
Telephone Number : 603-744-0275
Fax Number : 603-744-9378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2011
Last Update Date : 02/07/2012

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Directions to “ BRENT B MESERVE PT, DPT” Practice Location

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