Provider Demographics
NPI:1558539395
Name:PEDIATRIC PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PCS
Authorized Official - Phone:603-224-4540
Mailing Address - Street 1:124 HALL ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3478
Mailing Address - Country:US
Mailing Address - Phone:603-224-4540
Mailing Address - Fax:
Practice Address - Street 1:124 HALL ST
Practice Address - Street 2:SUITE H
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3478
Practice Address - Country:US
Practice Address - Phone:603-224-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty