Healthcare Provider Details

I. General information

NPI: 1730005380
Provider Name (Legal Business Name): RIVERS PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 N MAIN ST STE 206
CONCORD NH
03301-4926
US

IV. Provider business mailing address

18 N MAIN ST STE 206
CONCORD NH
03301-4926
US

V. Phone/Fax

Practice location:
  • Phone: 339-234-7602
  • Fax:
Mailing address:
  • Phone: 339-234-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE RIVERS
Title or Position: OWNER/SLPA
Credential: SLPA
Phone: 339-234-7602