Provider Demographics
NPI:1407319890
Name:PINE, DEBORAH (MPT, CSTA-CP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PINE
Suffix:
Gender:F
Credentials:MPT, CSTA-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 MESERVE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-5319
Mailing Address - Country:US
Mailing Address - Phone:603-953-5195
Mailing Address - Fax:
Practice Address - Street 1:60 POINTE PL STE 1
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4743
Practice Address - Country:US
Practice Address - Phone:603-740-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty