Provider Demographics
NPI:1699199679
Name:ANDERSON PEDIATRIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ANDERSON PEDIATRIC PHYSICAL THERAPY, LLC
Other - Org Name:PATTI-JEAN RAWDING-ANDERSON
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI-JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWDING-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:603-305-1811
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869
Mailing Address - Country:US
Mailing Address - Phone:603-305-1811
Mailing Address - Fax:603-658-4542
Practice Address - Street 1:431 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROLLINSFORD
Practice Address - State:NH
Practice Address - Zip Code:03869
Practice Address - Country:US
Practice Address - Phone:603-305-1811
Practice Address - Fax:603-658-4542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1202225100000X
MA4527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH781331OtherMVP
NH0803279Y0NH01OtherANTHEM BC / BS
NH3087347Medicaid