Healthcare Provider Details

I. General information

NPI: 1134856685
Provider Name (Legal Business Name): SAMANTHA BEAUDRY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 PLEASANT ST
CONCORD NH
03301-7504
US

IV. Provider business mailing address

17 CROSS RD
MONT VERNON NH
03057-1206
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-6561
  • Fax:
Mailing address:
  • Phone: 603-465-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5038
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: