Provider Demographics
NPI:1649371956
Name:PERFORMANCE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:PERFORMANCE PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUNTER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-924-3173
Mailing Address - Street 1:301 JAFFREY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1729
Mailing Address - Country:US
Mailing Address - Phone:603-924-3173
Mailing Address - Fax:603-371-9058
Practice Address - Street 1:301 JAFFREY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1729
Practice Address - Country:US
Practice Address - Phone:603-924-3173
Practice Address - Fax:603-371-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8914Medicare PIN