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General NPI Number Information
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NPI Number | 1952669897
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Entity Type | Organization
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Legal Business Name | GREAT BAY IN-HOME THERAPY
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Dates
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Enumeration Date | 04/29/2012
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Last Update Date | 04/29/2012
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Provider Practice Location Address
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Address Line | 206 LONGMARSH RD
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City | DURHAM
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State | NH
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Zip | 03824-4201
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Country | US
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Telephone | 603-801-4116
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Fax |
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Provider Business Mailing Address
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Address Line | 206 LONGMARSH RD
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City | DURHAM
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State | NH
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Zip | 03824-4201
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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 | ROSS ALLUMBAUGH
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Credential |
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Telephone | 603-801-4116
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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 | 3005
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License Number State | NH
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