MEDICARE: MS. LISA ANN ROTHERMICH LIC.AC.

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	171100000X	Acupuncturist	ACP002	NH

General Provider Information

NPI Number	:	1538806997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA ANN ROTHERMICH LIC.AC.

Provider Business Mailing Address
First Line	:	330 PORTSMOUTH AVE
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2220
Country	:	US
Telephone Number	:	603-436-6883
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 PORTSMOUTH AVE
Second Line	:
City	:	GREENLAND
State	:	NH
Zip	:	03840-2220
Country	:	US
Telephone Number	:	603-436-6883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2022
Last Update Date	:	05/17/2022

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