Provider Demographics
NPI:1174568646
Name:ORTHOPEDIC AND SPORT THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:ORTHOPEDIC AND SPORT THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRODEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-433-2101
Mailing Address - Street 1:150 GRIFFIN RD
Mailing Address - Street 2:STE 3
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7131
Mailing Address - Country:US
Mailing Address - Phone:603-433-2101
Mailing Address - Fax:603-427-6841
Practice Address - Street 1:150 GRIFFIN RD
Practice Address - Street 2:STE 3
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7131
Practice Address - Country:US
Practice Address - Phone:603-433-2101
Practice Address - Fax:603-427-6841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1174568646OtherNPI
NH1174568646OtherNPI