Provider Demographics
NPI:1134856685
Name:BEAUDRY, SAMANTHA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BEAUDRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:MONT VERNON
Mailing Address - State:NH
Mailing Address - Zip Code:03057-1206
Mailing Address - Country:US
Mailing Address - Phone:603-465-8570
Mailing Address - Fax:
Practice Address - Street 1:239 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7504
Practice Address - Country:US
Practice Address - Phone:603-224-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist