Provider Demographics
NPI:1477834018
Name:MESERVE, BRENT B (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:B
Last Name:MESERVE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0585
Mailing Address - Country:US
Mailing Address - Phone:603-536-4991
Mailing Address - Fax:
Practice Address - Street 1:790 LAKE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-4548
Practice Address - Country:US
Practice Address - Phone:603-744-0275
Practice Address - Fax:603-744-9378
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist