Healthcare Provider Details

I. General information

NPI: 1558640896
Provider Name (Legal Business Name): GEORGE SPARROW PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2011
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 RAYMOND RD UNIT 8
CANDIA NH
03034-2133
US

IV. Provider business mailing address

73 MANCHESTER ST APT 1
MANCHESTER NH
03101-2246
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3619
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: