Provider Demographics
NPI:1568463511
Name:KORSLUND, MARY SNOW (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SNOW
Last Name:KORSLUND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:40S RIVER RD 58
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6751
Mailing Address - Country:US
Mailing Address - Phone:603-626-4205
Mailing Address - Fax:603-666-6617
Practice Address - Street 1:173 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-891-4545
Practice Address - Fax:603-891-4548
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2015-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH0599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30392759Medicaid
NH30392759Medicaid