Provider Demographics
NPI:1689318420
Name:MOSENTHAL SPINE AND WELLNESS LLC
Entity Type:Organization
Organization Name:MOSENTHAL SPINE AND WELLNESS LLC
Other - Org Name:MOSENTHAL SPINE AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-536-5885
Mailing Address - Street 1:15 TOWN WEST RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3428
Mailing Address - Country:US
Mailing Address - Phone:603-536-5885
Mailing Address - Fax:603-238-9278
Practice Address - Street 1:15 TOWN WEST RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-536-5885
Practice Address - Fax:603-238-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty