MEDICARE: DIANE FRASER KEND PT

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	172M00000X	Mechanotherapist	1189	NH
2	172M00000X	Mechanotherapist	2230	ME
3	172M00000X	Mechanotherapist	9448	MA

General Provider Information

NPI Number	:	1851569255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE FRASER KEND PT

Provider Business Mailing Address
First Line	:	PO BOX 497
Second Line	:
City	:	MADISON
State	:	NH
Zip	:	03849-0497
Country	:	US
Telephone Number	:	603-447-1026
Fax Number	:	603-447-1026

Provider Business Practice Location Address
First Line	:	1005 MODOC HILL ROAD
Second Line	:
City	:	MADISON
State	:	NH
Zip	:	03849-0497
Country	:	US
Telephone Number	:	603-447-1026
Fax Number	:	603-447-1026

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

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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