Provider Demographics
NPI:1376688333
Name:SMITH, PETER FOSTER (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:FOSTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03827
Mailing Address - Country:US
Mailing Address - Phone:978-376-3651
Mailing Address - Fax:
Practice Address - Street 1:191 ELM ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-1814
Practice Address - Country:US
Practice Address - Phone:978-499-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69716Medicare ID - Type Unspecified