Healthcare Provider Details

I. General information

NPI: 1659283752
Provider Name (Legal Business Name): NICOLE RYAN WOODBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GROVE STREET
WOLFEBORO NH
03894
US

IV. Provider business mailing address

235 PINE ST
LACONIA NH
03246-3248
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-7972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1077
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: