1417047689 NPI number — FALL MOUNTAIN PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417047689 NPI number — FALL MOUNTAIN PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALL MOUNTAIN PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417047689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALSTEAD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03602-0057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-835-7828
Provider Business Mailing Address Fax Number:
603-835-7827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 NH ROUTE 12A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGDON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03602-8221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-835-7828
Provider Business Practice Location Address Fax Number:
603-835-7827
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
LISA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER, PT, ATC
Authorized Official Telephone Number:
603-835-7828

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  0036 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2994 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA65774 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 6007380 . This is a "MVP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 08Y007675NH03 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30394477 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF1145 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com