Provider Demographics
NPI:1124063284
Name:ROCHESTER PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ROCHESTER PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:603-692-6626
Mailing Address - Street 1:388 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1411
Mailing Address - Country:US
Mailing Address - Phone:603-692-6626
Mailing Address - Fax:603-692-4766
Practice Address - Street 1:388 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1411
Practice Address - Country:US
Practice Address - Phone:603-692-6626
Practice Address - Fax:603-692-4766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH8754863OtherCIGNA
ME4123600000Medicaid
NHAA27176OtherHARVARD PILGRIM HEALTH PL
ME4123600000Medicaid
NH8754863OtherCIGNA