Provider Demographics
NPI:1790236768
Name:WEISS, CHARLES (DPT)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AMORY ST
Mailing Address - Street 2:#3
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3551
Mailing Address - Country:US
Mailing Address - Phone:941-412-6144
Mailing Address - Fax:
Practice Address - Street 1:382 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-5046
Practice Address - Country:US
Practice Address - Phone:603-882-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH4134OtherSTATE LICENSE