Healthcare Provider Details

I. General information

NPI: 1447856489
Provider Name (Legal Business Name): PEDIATRIC THERAPY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2020
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 INDUSTRIAL PARK DR
NASHUA NH
03062-3178
US

IV. Provider business mailing address

20 INDUSTRIAL PARK DR
NASHUA NH
03062-3178
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-4500
  • Fax: 603-882-4545
Mailing address:
  • Phone: 603-882-4500
  • Fax: 603-882-4545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE CAMOSCIO
Title or Position: TREASURER
Credential: DPT
Phone: 781-789-5207