Provider Demographics
NPI:1154558492
Name:HOME ADVANTAGE PHYSICAL THERAPY
Entity type:Organization
Organization Name:HOME ADVANTAGE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:603-384-3966
Mailing Address - Street 1:140 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-5925
Mailing Address - Country:US
Mailing Address - Phone:603-384-3966
Mailing Address - Fax:
Practice Address - Street 1:140 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:WEARE
Practice Address - State:NH
Practice Address - Zip Code:03281-5925
Practice Address - Country:US
Practice Address - Phone:603-384-3966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-14
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2921261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy