Provider Demographics
NPI:1558347559
Name:OWOC PHYSICAL THERAPY & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:OWOC PHYSICAL THERAPY & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:OWOC
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-472-5546
Mailing Address - Street 1:20 COMMERCE PARK N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6911
Mailing Address - Country:US
Mailing Address - Phone:603-472-5546
Mailing Address - Fax:603-472-5095
Practice Address - Street 1:20 COMMERCE PARK N
Practice Address - Street 2:SUITE 103
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6911
Practice Address - Country:US
Practice Address - Phone:603-472-5546
Practice Address - Fax:603-472-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0789225100000X
PAPT005694L225100000X
MA5763225100000X
NH2232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7862579OtherCIGNA--GROUP ID
NH3078303Medicaid
NHNO GROUPOtherANTHEM--INDIVIDUAL ONLY
NH=========OtherAETNA--TIN ONLY
NH7862579OtherCIGNA--GROUP ID
NH7862579OtherCIGNA--GROUP ID