Provider Demographics
NPI:1568666881
Name:DENISE, ANNETTE JW (PT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:JW
Last Name:DENISE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29 SHATTIGEE ROAD
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1902
Mailing Address - Country:US
Mailing Address - Phone:603-895-2775
Mailing Address - Fax:
Practice Address - Street 1:442 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NH
Practice Address - Zip Code:03044-3434
Practice Address - Country:US
Practice Address - Phone:603-895-3126
Practice Address - Fax:603-895-3662
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24172251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics