Healthcare Provider Details

I. General information

NPI: 1902397011
Provider Name (Legal Business Name): DANIELE A CRUTCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PORTSMOUTH AVE
STRATHAM NH
03885-6528
US

IV. Provider business mailing address

20 PORTSMOUTH AVE
STRATHAM NH
03885-6528
US

V. Phone/Fax

Practice location:
  • Phone: 160-358-3511
  • Fax: 603-583-5364
Mailing address:
  • Phone: 160-358-3511
  • Fax: 603-583-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberNA
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: