Healthcare Provider Details

I. General information

NPI: 1215046271
Provider Name (Legal Business Name): GARY DESMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MILL RD UNIT B
DURHAM NH
03824-3047
US

IV. Provider business mailing address

10 CONTINENTAL BLVD
ROCHESTER NH
03867-4531
US

V. Phone/Fax

Practice location:
  • Phone: 603-868-2462
  • Fax:
Mailing address:
  • Phone: 603-335-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: