Individual
KEVIN WILSON SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
175 BLUEBERRY LN, LACONIA, NH 03246-2918
(603) 524-3340
Mailing address
22 RIDGEMONT DR, LONDONDERRY, NH 03053-3103
(603) 851-1163
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1210
NH
Other
Enumeration date
08/20/2015
Last updated
08/20/2015
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