Provider Demographics
NPI:1215046271
Name:DESMITH, GARY
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:DESMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONTINENTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-4531
Mailing Address - Country:US
Mailing Address - Phone:603-335-9217
Mailing Address - Fax:
Practice Address - Street 1:7 MILL RD UNIT B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-3047
Practice Address - Country:US
Practice Address - Phone:603-868-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2182OtherLICENSE #