Provider Demographics
NPI:1750679155
Name:MONTERISI, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MONTERISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 NORTH RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-6624
Practice Address - Country:US
Practice Address - Phone:603-658-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1024225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant