Healthcare Provider Details

I. General information

NPI: 1992085039
Provider Name (Legal Business Name): JULAINE E GELDERMANN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 HALL ST SUITE G/H
CONCORD NH
03301-3478
US

IV. Provider business mailing address

124 HALL ST SUITE G/H
CONCORD NH
03301-3478
US

V. Phone/Fax

Practice location:
  • Phone: 603-387-0119
  • Fax:
Mailing address:
  • Phone: 603-387-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1770
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: