Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 3375 | NH |
NPI | 1003069790 |
---|---|
Provider Name | Lindsay Mayock |
First Address | Conway, NH 03818-1828 |
Second Address | Conway, NH 03818-6166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 21/04/2016 |