Healthcare Provider Details

I. General information

NPI: 1871862755
Provider Name (Legal Business Name): HAMPSHIRE HILLS SPORT & FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EMERSON RD
MILFORD NH
03055-3516
US

IV. Provider business mailing address

50 EMERSON ROAD P.O. BOX 404
MILFORD NH
03055
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-7123
  • Fax: 603-673-0797
Mailing address:
  • Phone: 603-673-7123
  • Fax: 603-673-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK HOLDER
Title or Position: OWNER/ GENERAL MANAGER
Credential:
Phone: 603-673-7123