Provider Demographics
NPI:1174901441
Name:HOUGHTON, WARREN BRADLEY (LMT)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:BRADLEY
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MONUMENT SQUARE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809
Mailing Address - Country:US
Mailing Address - Phone:603-875-4000
Mailing Address - Fax:
Practice Address - Street 1:12 PORTWALK PL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4086
Practice Address - Country:US
Practice Address - Phone:603-431-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5040M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist