Healthcare Provider Details

I. General information

NPI: 1487180121
Provider Name (Legal Business Name): A KINGDOM FOR A HORSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 BLUEBERRY HILL RD
MEREDITH NH
03253-6603
US

IV. Provider business mailing address

36 BLUEBERRY HILL RD
MEREDITH NH
03253-6603
US

V. Phone/Fax

Practice location:
  • Phone: 603-217-7981
  • Fax:
Mailing address:
  • Phone: 603-217-7981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3691
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number3691
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number3691
License Number StateNH

VIII. Authorized Official

Name: FRANCISCA KING
Title or Position: CEO
Credential:
Phone: 603-217-7981