Provider Demographics
NPI:1861590465
Name:OPT: ORTHOPEDIC PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:OPT: ORTHOPEDIC PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:603-881-5554
Mailing Address - Street 1:155 MAIN DUNSTABLE RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3640
Mailing Address - Country:US
Mailing Address - Phone:603-881-5554
Mailing Address - Fax:603-595-7511
Practice Address - Street 1:155 MAIN DUNSTABLE RD
Practice Address - Street 2:SUITE 155
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3640
Practice Address - Country:US
Practice Address - Phone:603-881-5554
Practice Address - Fax:603-595-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3145225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHORRE5433Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#