Provider Demographics
NPI:1861585622
Name:WENTWORTH, PATRICIA GRACE (DC, ATC)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:GRACE
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:GRACE
Other - Last Name:WENTWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATHLETIC TRIANER
Mailing Address - Street 1:3 SARAH PAUL HILL
Mailing Address - Street 2:
Mailing Address - City:MADBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03823
Mailing Address - Country:US
Mailing Address - Phone:603-740-4499
Mailing Address - Fax:
Practice Address - Street 1:74 STATE RD, RET1
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-439-9045
Practice Address - Fax:207-703-0289
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6191200111N00000X
MA3932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH623901OtherCIGNA
NHAA19646OtherHPHC
NH05Y003913NH01OtherANTHEM
NHAA19646OtherHPHC