Healthcare Provider Details

I. General information

NPI: 1497372585
Provider Name (Legal Business Name): WHITE MOUNTAIN PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 WHITTIER HWY UNIT 3
MOULTONBOROUGH NH
03254
US

IV. Provider business mailing address

PO BOX 601
MOULTONBOROUGH NH
03254-0601
US

V. Phone/Fax

Practice location:
  • Phone: 603-273-1570
  • Fax:
Mailing address:
  • Phone: 603-273-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARK KURZ
Title or Position: OWNER
Credential: DPT
Phone: 518-275-5650