Basic Information
| Provider Information | |||||||||
| NPI: | 1194947028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYDER | ||||||||
| FirstName: | VIRGINIA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 AUTUMN RUN | ||||||||
| Address2: | |||||||||
| City: | HOOKSETT | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034943540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 239 PLEASANT STREET | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032246561 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0382 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.