Provider Demographics
NPI:1669459111
Name:GAILLARD, NANCY BETH (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BETH
Last Name:GAILLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:UNIT 58
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6751
Mailing Address - Country:US
Mailing Address - Phone:703-383-6454
Mailing Address - Fax:703-810-5494
Practice Address - Street 1:5 CLINTON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2303
Practice Address - Country:US
Practice Address - Phone:603-224-3511
Practice Address - Fax:603-224-3556
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28033174400000X
NH3763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13096Medicare ID - Type UnspecifiedGROUP