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General NPI Number Information
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NPI Number | 1225569171
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Entity Type | Organization
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Legal Business Name | POWER UP PHYSICAL THERAPY & FITNESS
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 39 LONGMEADOW DR
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City | BRENTWOOD
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State | NH
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Zip | 03833-6531
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Country | US
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Telephone | 919-272-0799
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Fax |
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Provider Business Mailing Address
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Address Line | 39 LONGMEADOW DR
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City | BRENTWOOD
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State | NH
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Zip | 03833-6531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | ANNETTE THOMAS
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Credential |
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Telephone | 919-272-0799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3890
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License Number State | NH
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