Organization
GRANITE STATE ADAPTIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER FRASER HAYNES PT (PRESIDENT)
(603) 387-1167
Entity
Organization
Contact information
Practice address
44 MIRROR LAKE DR, MIRROR LAKE, NH 03853-5953
(603) 387-1167
Mailing address
PO BOX 24, MIRROR LAKE, NH 03853-0024
(603) 387-1167
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
681
NH
225700000X
Massage Therapist
2924M
NH
Other
Enumeration date
06/17/2013
Last updated
06/17/2013
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