Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 21780 | MA |
N | 225200000X | Physical Therapy Assistant | 0971 | NH |
NPI | 1306178991 |
---|---|
Provider Name | Dr. Matt Litchfield |
First Address | Manchester, NH 03103-5054 |
Second Address | Boston, MA 02116-5109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2010 |
Last Update Date | 27/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21780 | ALLIED HEALTH PROFESSIONALS (01) | MA |