Provider Demographics
NPI:1295921088
Name:BEDFORD GERIATRIC PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:BEDFORD GERIATRIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:NANCY
Authorized Official - Last Name:PROSKA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:603-623-5300
Mailing Address - Street 1:108 RIVERWAY PLACE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-623-5300
Mailing Address - Fax:603-623-5335
Practice Address - Street 1:108 RIVERWAY PLACE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-623-5300
Practice Address - Fax:603-623-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH09802251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30398673Medicaid
NH0002700Medicare PIN
NH30398673Medicaid