1588674477 NPI number — HORSESHOE POND PHYSICAL THERAPY LLC

Table of content: (NPI 1588674477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588674477 NPI number — HORSESHOE POND PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORSESHOE POND 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:
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:
1588674477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 COMMERICAL ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-225-5132
Provider Business Mailing Address Fax Number:
603-225-6061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 COMMERICAL ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-225-5132
Provider Business Practice Location Address Fax Number:
603-225-6061
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONOHUE
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
603-225-5132

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6404291 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30391170 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53623 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA13115 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".




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