| Justin Clark, PT, DPT | |
|
1040 Whittier Highway, Unit 3, Moultonborough, NH 03254 | |
| (603) 273-1570 | |
| (603) 255-3559 |
| Full Name | Justin Clark |
|---|---|
| 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 |
|---|---|
| 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 |