Healthcare Provider Details

I. General information

NPI: 1457543050
Provider Name (Legal Business Name): CARLISLE PLACE PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAIN ST
LANCASTER NH
03584-3027
US

IV. Provider business mailing address

55 MAIN ST
LANCASTER NH
03584-3027
US

V. Phone/Fax

Practice location:
  • Phone: 603-586-6046
  • Fax: 603-586-0084
Mailing address:
  • Phone: 603-586-6046
  • Fax: 603-586-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. STACEY LYNN HICKS
Title or Position: OWNER
Credential: PT
Phone: 603-586-4100