1578782603 NPI number — ACE PHYSICAL THERAPY LLC

Table of content: (NPI 1578782603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578782603 NPI number — ACE PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACE PHYSICAL THERAPY LLC
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:
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:
1578782603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 PLEASANT ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-228-7500
Provider Business Mailing Address Fax Number:
603-228-3503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-228-7500
Provider Business Practice Location Address Fax Number:
603-228-3503
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COPPOLA
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR OWNER
Authorized Official Telephone Number:
603-228-7500

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  2164 , 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: 7052413 . This is a "AETNA PPO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0140699 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30393244 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA22614 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0805655Y0NH02 . This is a "BLUECROSS GROUP ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3709821 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 685494 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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