Healthcare Provider Details

I. General information

NPI: 1912949496
Provider Name (Legal Business Name): SEACOAST AREA PHYSIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 GREENLAND RD BUILDING C-4
PORTSMOUTH NH
03801-4164
US

IV. Provider business mailing address

875 GREENLAND RD BUILDING C-4
PORTSMOUTH NH
03801-4164
US

V. Phone/Fax

Practice location:
  • Phone: 603-431-5529
  • Fax: 603-436-6603
Mailing address:
  • Phone: 603-431-5529
  • Fax: 603-436-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNH

VIII. Authorized Official

Name: DR. BRUCE R MYERS
Title or Position: PRESIDENT
Credential: MD
Phone: 603-431-5529