Basic Information
| Provider Information | |||||||||
| NPI: | 1447460621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANLEY | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | ARNOLD | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 WASHINGTON ST | ||||||||
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| City: | EXETER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038332017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037780884 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 TUCK RD | ||||||||
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| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038421225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039264551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0820 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.