Healthcare Provider Details

I. General information

NPI: 1447170303
Provider Name (Legal Business Name): CHARLES TABAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1 JAFFREY RD STE 9
PETERBOROUGH NH
03458-1707
US

IV. Provider business mailing address

103 HILLSIDE DR
HENNIKER NH
03242-3572
US

V. Phone/Fax

Practice location:
  • Phone: 603-801-2241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5145
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: