Provider Demographics
NPI:1609030741
Name:DURHAM PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DURHAM PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-868-1900
Mailing Address - Street 1:331 PACKERS FALLS RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-4404
Mailing Address - Country:US
Mailing Address - Phone:603-868-1900
Mailing Address - Fax:603-868-1900
Practice Address - Street 1:331 PACKERS FALLS RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-4404
Practice Address - Country:US
Practice Address - Phone:603-868-1900
Practice Address - Fax:603-868-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE1394Medicare UPIN