Healthcare Provider Details

I. General information

NPI: 1093936890
Provider Name (Legal Business Name): HARRY LICHTMAN PTA, CEAS II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEW HAMPSHIRE AVE STE 105
PORTSMOUTH NH
03801-2841
US

IV. Provider business mailing address

39 KIMBALL WAY
NEWMARKET NH
03857-2113
US

V. Phone/Fax

Practice location:
  • Phone: 603-430-9675
  • Fax:
Mailing address:
  • Phone: 603-659-5383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0482
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: