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General NPI Number Information
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NPI Number | 1457097974
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Entity Type | Organization
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Legal Business Name | PROAGING REHAB AND WELLNESS LLC
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Dates
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Enumeration Date | 05/08/2022
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Last Update Date | 05/22/2022
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Provider Practice Location Address
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Address Line | 5 NOTTINGHAM LN
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City | SALEM
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State | NH
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Zip | 03079-5203
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Country | US
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Telephone | 603-401-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 5 NOTTINGHAM LN
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City | SALEM
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State | NH
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Zip | 03079-5203
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Country | US
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Telephone | 603-401-7141
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA LEE BRACKETT
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Credential | MPT
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Telephone | 603-401-7141
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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 |
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License Number State |
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