Healthcare Provider Details

I. General information

NPI: 1659753226
Provider Name (Legal Business Name): SHANTELLE B CYR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 RAYMOND RD
CANDIA NH
03034
US

IV. Provider business mailing address

143 RAYMOND RD
CANDIA NH
03034-2133
US

V. Phone/Fax

Practice location:
  • Phone: 603-483-3355
  • Fax: 603-483-3357
Mailing address:
  • Phone: 603-483-3355
  • Fax: 603-483-3357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4556
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: