Healthcare Provider Details

I. General information

NPI: 1568463511
Provider Name (Legal Business Name): MARY SNOW KORSLUND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 DANIEL WEBSTER HWY
NASHUA NH
03060
US

IV. Provider business mailing address

40S RIVER RD 58
BEDFORD NH
03110-6751
US

V. Phone/Fax

Practice location:
  • Phone: 603-891-4545
  • Fax: 603-891-4548
Mailing address:
  • Phone: 603-626-4205
  • Fax: 603-666-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0599
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: