Provider Demographics
NPI:1508244765
Name:CORSETTI, DANIEL R (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:CORSETTI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4753
Mailing Address - Country:US
Mailing Address - Phone:603-988-9513
Mailing Address - Fax:
Practice Address - Street 1:775 LAFAYETTE RD STE 9
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5434
Practice Address - Country:US
Practice Address - Phone:603-431-9700
Practice Address - Fax:603-431-9701
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3102475Medicaid