Healthcare Provider Details

I. General information

NPI: 1689318420
Provider Name (Legal Business Name): MOSENTHAL SPINE AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TOWN WEST RD
PLYMOUTH NH
03264-3428
US

IV. Provider business mailing address

15 TOWN WEST RD
PLYMOUTH NH
03264-3428
US

V. Phone/Fax

Practice location:
  • Phone: 603-536-5885
  • Fax: 603-238-9278
Mailing address:
  • Phone: 603-536-5885
  • Fax: 603-238-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TODD M. MOSENTHAL
Title or Position: PRESIDENT
Credential:
Phone: 603-536-5885