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General NPI Number Information
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NPI Number | 1093936890
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Entity Type | Individual
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Provider Name | HARRY LICHTMAN PTA, CEAS II
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 25 NEW HAMPSHIRE AVE STE 105
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City | PORTSMOUTH
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State | NH
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Zip | 03801-2841
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Country | US
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Telephone | 603-430-9675
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Fax |
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Provider Business Mailing Address
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Address Line | 39 KIMBALL WAY
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City | NEWMARKET
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State | NH
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Zip | 03857-2113
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Country | US
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Telephone | 603-659-5383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0482
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License Number State | NH
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