Healthcare Provider Details

I. General information

NPI: 1497695399
Provider Name (Legal Business Name): SAMUEL ANDERS GAGNON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALUMNI DR
EXETER NH
03833-2118
US

IV. Provider business mailing address

17 BROWNS CT APT B
EXETER NH
03833-2808
US

V. Phone/Fax

Practice location:
  • Phone: 603-778-7311
  • Fax:
Mailing address:
  • Phone: 603-703-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0020938
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4669
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: