Healthcare Provider Details

I. General information

NPI: 1821588328
Provider Name (Legal Business Name): NORTH COUNTRY PHYSICAL THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BACK LAKE RD
PITTSBURG NH
03592-5402
US

IV. Provider business mailing address

19 BACK LAKE RD
PITTSBURG NH
03592-5402
US

V. Phone/Fax

Practice location:
  • Phone: 603-369-0228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARTHA WELLS
Title or Position: MANAGER/THERAPIST
Credential: PT, DPT
Phone: 603-369-0228