Provider Demographics
NPI:1942426192
Name:STOCKWELL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:STOCKWELL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STOCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-746-5600
Mailing Address - Street 1:54 PARK AVE PLAZA
Mailing Address - Street 2:PO BOX 819
Mailing Address - City:CONTOOCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03229-0819
Mailing Address - Country:US
Mailing Address - Phone:603-746-5600
Mailing Address - Fax:603-746-5610
Practice Address - Street 1:54 PARK AVE PLAZA
Practice Address - Street 2:
Practice Address - City:CONTOOCOOK
Practice Address - State:NH
Practice Address - Zip Code:03229-0819
Practice Address - Country:US
Practice Address - Phone:603-746-5600
Practice Address - Fax:603-746-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty