Healthcare Provider Details

I. General information

NPI: 1962661322
Provider Name (Legal Business Name): ERIC R GATTIE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 PLEASANT ST
CONCORD NH
03301-2551
US

IV. Provider business mailing address

264 PLEASANT ST
CONCORD NH
03301-2551
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-4610
  • Fax: 603-228-7264
Mailing address:
  • Phone: 603-228-4610
  • Fax: 603-228-7264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3326
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: