Provider Demographics
NPI:1881682474
Name:TAYESE LLC
Entity Type:Organization
Organization Name:TAYESE LLC
Other - Org Name:NORTHWOOD PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TOYIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ATORO-ODUEYUNGBO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-942-9933
Mailing Address - Street 1:PO BOX 4136
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-4136
Mailing Address - Country:US
Mailing Address - Phone:603-942-9933
Mailing Address - Fax:603-224-5601
Practice Address - Street 1:488 FIRST NH TPKE
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3410
Practice Address - Country:US
Practice Address - Phone:603-942-9933
Practice Address - Fax:603-224-5601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYESE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6629Medicare ID - Type UnspecifiedPHYSICAL THERAPY