Healthcare Provider Details

I. General information

NPI: 1467251058
Provider Name (Legal Business Name): BLUE TANG PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LAFAYETTE RD STE C
NORTH HAMPTON NH
03862-2437
US

IV. Provider business mailing address

29 LAFAYETTE RD STE C
NORTH HAMPTON NH
03862-2437
US

V. Phone/Fax

Practice location:
  • Phone: 603-231-1774
  • Fax:
Mailing address:
  • Phone: 603-231-1774
  • Fax: 855-975-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BONNIE ECKERMAN
Title or Position: OWNER
Credential: DPT
Phone: 603-275-9124