Healthcare Provider Details

I. General information

NPI: 1124062302
Provider Name (Legal Business Name): WILLIAM J CIOFFREDI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MORGAN DR
LEBANON NH
03766-1408
US

IV. Provider business mailing address

112 ETNA RD
LEBANON NH
03766-1454
US

V. Phone/Fax

Practice location:
  • Phone: 603-643-7788
  • Fax: 603-643-0022
Mailing address:
  • Phone: 603-643-7788
  • Fax: 603-643-0022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0490
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: