Healthcare Provider Details

I. General information

NPI: 1184747941
Provider Name (Legal Business Name): SUSAN P RADCLIFFE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SNOW RD
WINCHESTER NH
03470-2806
US

IV. Provider business mailing address

PO BOX 233
PLYMOUTH NH
03264-0233
US

V. Phone/Fax

Practice location:
  • Phone: 603-239-6355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberEL31842
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0535
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: