Provider Demographics
NPI:1679754964
Name:PLAINFIELD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PLAINFIELD PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-675-2600
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781-0130
Mailing Address - Country:US
Mailing Address - Phone:603-675-2600
Mailing Address - Fax:603-675-2644
Practice Address - Street 1:1110 RT 12A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NH
Practice Address - Zip Code:03781
Practice Address - Country:US
Practice Address - Phone:603-675-2600
Practice Address - Fax:603-675-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y007904NH01OtherANTHEM
NH30393503Medicaid
NHPLRE8059Medicare PIN