Provider Demographics
NPI:1295801074
Name:GILFORD PHYSICAL THERAPY & SPINE CENTER, PLLC
Entity type:Organization
Organization Name:GILFORD PHYSICAL THERAPY & SPINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, DIRECTOR,MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANG-RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:603-528-4152
Mailing Address - Street 1:689 GILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-7550
Mailing Address - Country:US
Mailing Address - Phone:603-528-4152
Mailing Address - Fax:603-528-1591
Practice Address - Street 1:689 GILFORD AVE
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-7550
Practice Address - Country:US
Practice Address - Phone:603-528-4152
Practice Address - Fax:603-528-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH07152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE 9022Medicare UPIN
NH5926840001Medicare NSC