Healthcare Provider Details

I. General information

NPI: 1669459111
Provider Name (Legal Business Name): NANCY BETH GAILLARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CLINTON ST
CONCORD NH
03301-2303
US

IV. Provider business mailing address

40 S RIVER RD UNIT 58
BEDFORD NH
03110-6751
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-3511
  • Fax: 603-224-3556
Mailing address:
  • Phone: 703-383-6454
  • Fax: 703-810-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 28033
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3763
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: