Justin Clark, PT, DPT | |
1040 Whittier Highway, Unit 3, Moultonborough, NH 03254 | |
(603) 273-1570 | |
(603) 255-3559 |
Full Name | Justin Clark |
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Gender | Male |
Speciality | Physical Therapist |
Location | 1040 Whittier Highway, Moultonborough, New Hampshire |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1952020513 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 5052 (New Hampshire) | Primary |
Provider Name | White Mountain Physical Therapy Pllc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1497372585 PECOS PAC ID: 2567889165 Enrollment ID: O20201030000559 |
Mailing Address | Practice Location Address |
---|---|
Justin Clark, PT, DPT 54 W Parish Rd, Concord, NH 03303-4130 Ph: (603) 660-9801 | Justin Clark, PT, DPT 1040 Whittier Highway, Unit 3, Moultonborough, NH 03254 Ph: (603) 273-1570 |
Mikaela Leslie Shields, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 1040 Whittier Hwy, Moultonborough, NH 03254 Phone: 603-273-1570 | |
White Mountain Physical Therapy, Pllc Physical Therapist Medicare: Medicare Enrolled Practice Location: 1040 Whittier Hwy, Unit 3, Moultonborough, NH 03254 Phone: 603-273-1570 | |
Allyson Coggins, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1040 Whittier Hwy, Moultonborough, NH 03254 Phone: 603-273-1570 |