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General NPI Number Information
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NPI Number | 1215167556
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Entity Type | Organization
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Legal Business Name | RAGGED MOUNTAIN ORTHOPAEDIC & SPORTS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 10 LAWRENCE STREET
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City | ANDOVER
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State | NH
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Zip | 03216
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Country | US
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Telephone | 603-735-5114
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | ANDOVER
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State | NH
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Zip | 03216-0146
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Country | US
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Telephone | 603-735-5114
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DIANE FOWLER
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Credential | MPT
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Telephone | 603-735-5114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2130
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License Number State | NH
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