=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265819676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATURA PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2015
-----------------------------------------------------
Last Update Date | 05/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 GILCREAST RD UNIT 310
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-547-9465
-----------------------------------------------------
Fax | 603-552-5214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 GILCREAST RD UNIT 310
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-547-9465
-----------------------------------------------------
Fax | 603-552-5214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALINE FLORES
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 603-547-9465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2234
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------