Healthcare Provider Details

I. General information

NPI: 1609075274
Provider Name (Legal Business Name): DAVID JOHN CORMIER DO, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MARSH BROOK DR STE 100
SOMERSWORTH NH
03878-6523
US

IV. Provider business mailing address

7 MARSH BROOK DR STE 205
SOMERSWORTH NH
03878-6523
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-2007
  • Fax: 603-749-4605
Mailing address:
  • Phone: 603-742-2007
  • Fax: 603-749-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberLP02592
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3414
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17919
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400003732
License Number StateVT
# 5
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number18356
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: