Healthcare Provider Details

I. General information

NPI: 1578920534
Provider Name (Legal Business Name): STEPHEN GRAHAM BARWISE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GARVINS FALLS RD
CONCORD NH
03301-5174
US

IV. Provider business mailing address

6 GARVINS FALLS RD
CONCORD NH
03301-5174
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-3397
  • Fax: 603-524-9364
Mailing address:
  • Phone: 603-524-3397
  • Fax: 603-524-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2669
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: