Provider Demographics
NPI:1962943803
Name:MEMMESHEIMER, HENRY CHARLES III (PTA)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:CHARLES
Last Name:MEMMESHEIMER
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALLENS AVE
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:NH
Mailing Address - Zip Code:03861-6531
Mailing Address - Country:US
Mailing Address - Phone:603-502-5138
Mailing Address - Fax:
Practice Address - Street 1:188 JONES AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5516
Practice Address - Country:US
Practice Address - Phone:603-431-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH636225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant