Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2533 | NH |
NPI | 1003070855 |
---|---|
Provider Name | Derek C Eastman |
First Address | Gorham, NH 03581 |
Second Address | Gorham, NH 03581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 10/07/2008 |