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General NPI Number Information
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NPI Number | 1154909786
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Entity Type | Individual
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Provider Name | MRS. ALYSIA NICOLE REDARD
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | GOLDEN BROOK SCHOOL 112B LOWELL ROAD
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City | WINDHAM
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State | NH
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Zip | 03087-0308
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Country | US
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Telephone | 603-845-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 55 OVERTON RD
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City | WINDHAM
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State | NH
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Zip | 03087-1265
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Country | US
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Telephone | 603-943-0467
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 3509
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License Number State | NH
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