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General NPI Number Information
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NPI Number | 1205100096
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Entity Type | Organization
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Legal Business Name | PERFORMANCE HEALTH SPINE & SPORT THERAPY
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 91A N STATE ST
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City | CONCORD
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State | NH
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Zip | 03301-4334
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Country | US
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Telephone | 603-724-2297
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Fax | 603-369-3017
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Provider Business Mailing Address
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Address Line | 91A N STATE ST
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City | CONCORD
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State | NH
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Zip | 03301-4334
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Country | US
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Telephone | 603-724-2297
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Fax | 603-369-3017
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. BRETT COAPLAND
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Credential | DC, CSCS, ART
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Telephone | 603-724-2297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 965
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3813
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License Number State | NH
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 20597
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 7850407
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License Number State | NH
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