Healthcare Provider Details

I. General information

NPI: 1083829030
Provider Name (Legal Business Name): GREENWOOD THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ANSEL ST
SALEM NH
03079-4550
US

IV. Provider business mailing address

18 ANSEL ST
SALEM NH
03079-4550
US

V. Phone/Fax

Practice location:
  • Phone: 603-401-3830
  • Fax: 603-458-2121
Mailing address:
  • Phone: 603-401-3830
  • Fax: 603-458-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number11594
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2622
License Number StateNH

VIII. Authorized Official

Name: MR. JONATHAN MARK GREENWOOD
Title or Position: OWNER
Credential: PT
Phone: 603-401-3830