Provider Demographics
NPI:1033342308
Name:EDGERTON, MARY M (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:EDGERTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DERRY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3023
Mailing Address - Country:US
Mailing Address - Phone:603-598-0729
Mailing Address - Fax:603-598-0864
Practice Address - Street 1:300 DERRY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-3023
Practice Address - Country:US
Practice Address - Phone:603-598-0729
Practice Address - Fax:603-598-0864
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist