Provider Demographics
NPI:1922106467
Name:SPORT AND SPINE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:SPORT AND SPINE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-292-5915
Mailing Address - Street 1:775 LAFAYETTE RD STE 9
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5434
Mailing Address - Country:US
Mailing Address - Phone:603-431-9700
Mailing Address - Fax:603-431-9701
Practice Address - Street 1:775 LAFAYETTE RD STE 9
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5434
Practice Address - Country:US
Practice Address - Phone:603-431-9700
Practice Address - Fax:603-431-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076896Medicaid