Healthcare Provider Details

I. General information

NPI: 1821215070
Provider Name (Legal Business Name): MARK EDWARD FIFIELD PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-7539
US

IV. Provider business mailing address

721 SHAKER RD
NORTHFIELD NH
03276-4452
US

V. Phone/Fax

Practice location:
  • Phone: 603-230-1250
  • Fax:
Mailing address:
  • Phone: 603-286-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0447
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: