Randi Bagley
Individual provider Active NPI Physical Therapy Assistant · N Haverhill, NH
NPI 1497062020 · NPPES record last updated Sep 2, 2010
Key facts
- NPI
- 1497062020
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 0646 (NH)
- Practice address
- 3855 Dartmouth College Hwy
N Haverhill, NH 03774-4937 - Phone
- (603) 546-7416
- NPI assigned
- Sep 2, 2010
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0646 | NH | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 0646 | NH | Yes |
Addresses
Primary practice location
3855 Dartmouth College Hwy
N Haverhill, NH 03774-4937
Mailing address
3855 Dartmouth College Hwy
N Haverhill, NH 03774-4937
Phone (603) 546-7416
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.