Provider Demographics
NPI:1114950318
Name:STRATHAM PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STRATHAM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DATTILO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-772-8222
Mailing Address - Street 1:64 PORTSMOUTH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2523
Mailing Address - Country:US
Mailing Address - Phone:603-772-8222
Mailing Address - Fax:603-772-6738
Practice Address - Street 1:64 PORTSMOUTH AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2523
Practice Address - Country:US
Practice Address - Phone:603-772-8222
Practice Address - Fax:603-772-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8243Medicare ID - Type Unspecified
NHRE8484Medicare ID - Type Unspecified