Active NPI
Candice E Derusha, PT
- Physical Therapist
- Concord, NH
National Provider Identifier
1104087097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3335
- Practice address
- 264 Pleasant St
Concord, NH 03301-2551 - Phone
- (603) 228-4610
- Fax
- (603) 228-7264
- NPI assigned
- Jun 23, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3335 | NH | Primary |
Addresses
Primary practice location
264 Pleasant St
Concord, NH 03301-2551
Mailing address
250 Pleasant St
Concord, NH 03301-7539
Phone (603) 228-4610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3335 | NH | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214179200000",
"number": "1104087097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 PLEASANT ST",
"city": "CONCORD",
"state": "NH",
"postal_code": "033017539",
"telephone_number": "603-228-4610",
"fax_number": "603-228-7264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "264 PLEASANT ST",
"city": "CONCORD",
"state": "NH",
"postal_code": "033012551",
"telephone_number": "603-228-4610",
"fax_number": "603-228-7264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERUSHA",
"first_name": "CANDICE",
"middle_name": "E",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-06-23",
"last_updated": "2008-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NH",
"license": "3335",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.