Provider Demographics
NPI:1689081606
Name:KRISTEN TRAHAN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KRISTEN TRAHAN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/P.T.
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-444-9865
Mailing Address - Street 1:262 COTTAGE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4152
Mailing Address - Country:US
Mailing Address - Phone:603-444-9865
Mailing Address - Fax:603-444-9865
Practice Address - Street 1:262 COTTAGE ST STE 130
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4152
Practice Address - Country:US
Practice Address - Phone:603-444-9865
Practice Address - Fax:603-444-9865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3080316Medicaid
NH3080316Medicaid