Healthcare Provider Details

I. General information

NPI: 1770166332
Provider Name (Legal Business Name): MRS. SARAH DUDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 INNOVATIVE WAY STE PT
NASHUA NH
03062-5701
US

IV. Provider business mailing address

576 BROADHOLLOW RD STE PROEX
MELVILLE NY
11747-5002
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-2592
  • Fax: 978-649-4620
Mailing address:
  • Phone: 631-359-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2481
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: