Provider Demographics
NPI:1679632012
Name:GRANITE STATE PHYSICAL THERAPY CONCORD PLLC
Entity Type:Organization
Organization Name:GRANITE STATE PHYSICAL THERAPY CONCORD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-410-6309
Mailing Address - Street 1:8 LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5300
Mailing Address - Country:US
Mailing Address - Phone:603-410-6309
Mailing Address - Fax:603-410-6310
Practice Address - Street 1:8 LOUDON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5300
Practice Address - Country:US
Practice Address - Phone:603-410-6309
Practice Address - Fax:603-410-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8937Medicare ID - Type Unspecified