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General NPI Number Information
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NPI Number | 1801665724
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Entity Type | Organization
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Legal Business Name | GATE CITY SPORTS MEDICINE
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Dates
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Enumeration Date | 12/20/2023
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 436 AMHERST ST STE 102
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City | NASHUA
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State | NH
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Zip | 03063-1276
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Country | US
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Telephone | 603-417-5087
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Fax | 603-417-5089
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Provider Business Mailing Address
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Address Line | 436 AMHERST ST STE 102
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City | NASHUA
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State | NH
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Zip | 03063-1276
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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
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Name | DR. KEITH LEVESQUE
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Credential | PT, DPT, OCS
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Telephone | 603-417-5087
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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