Provider Demographics
NPI:1194771139
Name:MERRIMACK VALLEY PHYSICAL THERAPY
Entity type:Organization
Organization Name:MERRIMACK VALLEY PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-696-9524
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:BEDFORD PLACE, UNIT 58
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6719
Mailing Address - Country:US
Mailing Address - Phone:603-626-4205
Mailing Address - Fax:603-666-6617
Practice Address - Street 1:40 S RIVER RD
Practice Address - Street 2:BEDFORD PLACE, UNIT 58
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6719
Practice Address - Country:US
Practice Address - Phone:603-626-4205
Practice Address - Fax:603-666-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE6832Medicare PIN