Provider Demographics
NPI:1053471607
Name:NORTHERN PHYSICAL THERAPY & REHAB SERVICES LLC
Entity Type:Organization
Organization Name:NORTHERN PHYSICAL THERAPY & REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-285-0635
Mailing Address - Street 1:35 HAMPDEN PL
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1477
Mailing Address - Country:US
Mailing Address - Phone:860-285-0635
Mailing Address - Fax:860-271-8015
Practice Address - Street 1:34 NORTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2264
Practice Address - Country:US
Practice Address - Phone:207-764-0400
Practice Address - Fax:207-764-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDF5848OtherRAILROAD MEDICARE