Provider Demographics
NPI:1851591812
Name:MATTSON, ELIZABETH RILEY (PT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:RILEY
Last Name:MATTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 JENNESS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:NH
Mailing Address - Zip Code:03222-3812
Mailing Address - Country:US
Mailing Address - Phone:603-381-4652
Mailing Address - Fax:
Practice Address - Street 1:315 JENNESS HILL RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-3812
Practice Address - Country:US
Practice Address - Phone:603-381-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010361Medicaid