Healthcare Provider Details

I. General information

NPI: 1376690149
Provider Name (Legal Business Name): MR. ERIC VENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RYE ST STE 125
PORTSMOUTH NH
03801-6839
US

IV. Provider business mailing address

15 RYE ST STE 125
PORTSMOUTH NH
03801-6839
US

V. Phone/Fax

Practice location:
  • Phone: 603-310-2200
  • Fax: 603-610-2202
Mailing address:
  • Phone: 603-310-2200
  • Fax: 603-610-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2816
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: