Healthcare Provider Details

I. General information

NPI: 1407672827
Provider Name (Legal Business Name): FARMINGTON PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 NH ROUTE 11
FARMINGTON NH
03835-3844
US

IV. Provider business mailing address

395 NH ROUTE 11
FARMINGTON NH
03835-3844
US

V. Phone/Fax

Practice location:
  • Phone: 603-839-1034
  • Fax:
Mailing address:
  • Phone: 603-839-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BONNIE PICKETT
Title or Position: MANAGER
Credential:
Phone: 603-839-1034