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General NPI Number Information
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NPI Number | 1659485423
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Entity Type | Organization
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Legal Business Name | GRANITE PHYSIATRY, PLLC
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 05/15/2019
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Provider Practice Location Address
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Address Line | 60 COMMERCIAL ST STE 303
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City | CONCORD
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State | NH
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Zip | 03301-5071
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Country | US
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Telephone | 603-223-8145
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Fax | 603-223-8146
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Provider Business Mailing Address
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Address Line | 60 COMMERCIAL ST STE 303
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City | CONCORD
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State | NH
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Zip | 03301-5096
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Country | US
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Telephone | 603-223-8145
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Fax | 603-223-8146
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Authorized Official
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Title or Position | OWNER
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Name | MR. STUART GLASSMAN
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Credential | MD
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Telephone | 603-223-8145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 9153
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License Number State | NH
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