Provider Demographics
NPI:1417608787
Name:UNTAPPED POTENTIAL PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:UNTAPPED POTENTIAL PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEAUREGARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:978-430-4555
Mailing Address - Street 1:6 KILN DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03052-2472
Mailing Address - Country:US
Mailing Address - Phone:978-726-2779
Mailing Address - Fax:
Practice Address - Street 1:35 LONDONDERRY TPKE UNIT F
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-2029
Practice Address - Country:US
Practice Address - Phone:978-219-4473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy