Individual
AMANDA SLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
249 COUNTY RD, NEW LONDON, NH 03257-5795
(603) 526-5256
Mailing address
PO BOX 18, GEORGES MILLS, NH 03751-0018
(603) 863-8936
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2047
NH
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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