Provider Demographics
NPI:1215954946
Name:WEEKS AND GOWEN PHYSICAL THERAPY ASSOCIATES INC
Entity type:Organization
Organization Name:WEEKS AND GOWEN PHYSICAL THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA MAE
Authorized Official - Middle Name:PUNGOT
Authorized Official - Last Name:RASTODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-880-0448
Mailing Address - Street 1:PO BOX 1467
Mailing Address - Street 2:23 CARYL LANE
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603
Mailing Address - Country:US
Mailing Address - Phone:603-826-9700
Mailing Address - Fax:603-826-9703
Practice Address - Street 1:23 CARYL LANE
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03603
Practice Address - Country:US
Practice Address - Phone:603-826-9700
Practice Address - Fax:603-826-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
63042OtherCIGNA CLARE B GOWEN
H003983OtherCHAMPUS
563021OtherUS HEALTHCARE
563330OtherUS HEALTHCARE GROUP
VT18028OtherBCBS
613627OtherTUFTS
NH80001596Medicaid
626558OtherHARVARD PILGRIM
VTWEEK18026OtherBCBS
0805417YONH01OtherANTHEM
63040OtherCIGNA GROUP
RE6706Medicare ID - Type UnspecifiedGROUP