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General NPI Number Information
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NPI Number | 1366704918
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Entity Type | Organization
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Legal Business Name | PATRIOT PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 40 S RIVER RD BEDFORD PLACE UNIT 63
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City | BEDFORD
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State | NH
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Zip | 03110-6719
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Country | US
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Telephone | 603-689-3193
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Fax |
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Provider Business Mailing Address
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Address Line | 49 OLD BEDFORD RD
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City | BEDFORD
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State | NH
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Zip | 03110-5927
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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 | OWNER/PHYSICAL THERAPIST
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Name | HEATHER MARKIEWICZ
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Credential |
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Telephone | 603-689-3193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 3017
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License Number State | NH
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