MEDICARE: LISA MARIE WHELDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3628	NH

General Provider Information

NPI Number	:	1578851069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE WHELDON

Provider Business Mailing Address
First Line	:	73 NEWTON RD
Second Line	:	STE 101
City	:	PLAISTOW
State	:	NH
Zip	:	03865-2424
Country	:	US
Telephone Number	:	978-388-7272
Fax Number	:	978-388-7373

Provider Business Practice Location Address
First Line	:	920 LAFAYETTE RD
Second Line	:	2ND FLOOR
City	:	SEABROOK
State	:	NH
Zip	:	03874-4216
Country	:	US
Telephone Number	:	603-474-2259
Fax Number	:	603-474-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	06/25/2015

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Directions to “ LISA MARIE WHELDON ” Practice Location

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