Provider Demographics
NPI:1922031137
Name:WHITE MOUNTAIN PHYSICAL THERAPY LP
Entity Type:Organization
Organization Name:WHITE MOUNTAIN PHYSICAL THERAPY LP
Other - Org Name:WHITE MOUNTAIN PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP,AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:1300 W SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2447
Mailing Address - Country:US
Mailing Address - Phone:713-297-7000
Mailing Address - Fax:713-297-7090
Practice Address - Street 1:LINCOLN SQUARE
Practice Address - Street 2:UNIT 4
Practice Address - City:LINCOLN
Practice Address - State:NH
Practice Address - Zip Code:03251
Practice Address - Country:US
Practice Address - Phone:603-745-4334
Practice Address - Fax:603-745-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHWH RE5562Medicare ID - Type UnspecifiedMEDICARE PART B