Provider Demographics
NPI:1851388169
Name:MERCER, GARY L (PT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:MERCER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BREWERY LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4994
Mailing Address - Country:US
Mailing Address - Phone:603-430-3004
Mailing Address - Fax:603-430-0045
Practice Address - Street 1:95 BREWERY LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4994
Practice Address - Country:US
Practice Address - Phone:603-430-3004
Practice Address - Fax:603-430-0045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393236Medicaid
NH30393236Medicaid