Provider Demographics
NPI:1912085267
Name:DOVER PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DOVER PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN-GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-740-1300
Mailing Address - Street 1:393 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6105
Mailing Address - Country:US
Mailing Address - Phone:603-879-0672
Mailing Address - Fax:603-418-8905
Practice Address - Street 1:42 DOVER POINT RD UNIT M
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4669
Practice Address - Country:US
Practice Address - Phone:603-740-1300
Practice Address - Fax:603-740-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7412Medicare ID - Type Unspecified