Healthcare Provider Details

I. General information

NPI: 1114838463
Provider Name (Legal Business Name): DEFENDER PHYSICAL THERAPY AND FITNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 GAUTHIER DR
EPSOM NH
03234-4150
US

IV. Provider business mailing address

317 NEW ORCHARD RD
EPSOM NH
03234-4423
US

V. Phone/Fax

Practice location:
  • Phone: 603-736-9656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS DAVIS
Title or Position: PRESIDENT AND CEO
Credential: PT
Phone: 607-351-8200