Provider Demographics
NPI:1679864524
Name:SMART PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SMART PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-526-7627
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-1557
Mailing Address - Country:US
Mailing Address - Phone:603-526-7627
Mailing Address - Fax:603-676-7967
Practice Address - Street 1:11 PLEASANT ST.
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257
Practice Address - Country:US
Practice Address - Phone:603-526-7627
Practice Address - Fax:603-676-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3343261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy