Healthcare Provider Details

I. General information

NPI: 1255109971
Provider Name (Legal Business Name): ERIN HANLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 TOWN HALL RD
INTERVALE NH
03845-6107
US

IV. Provider business mailing address

277 TOWN HALL RD
INTERVALE NH
03845-6107
US

V. Phone/Fax

Practice location:
  • Phone: 781-864-5571
  • Fax:
Mailing address:
  • Phone: 781-864-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1419
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: