Healthcare Provider Details

I. General information

NPI: 1558347559
Provider Name (Legal Business Name): OWOC PHYSICAL THERAPY & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COMMERCE PARK N SUITE 103
BEDFORD NH
03110-6911
US

IV. Provider business mailing address

20 COMMERCE PARK N SUITE 103
BEDFORD NH
03110-6911
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-5546
  • Fax: 603-472-5095
Mailing address:
  • Phone: 603-472-5546
  • Fax: 603-472-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005694L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5763
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2232
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0789
License Number StateNH

VIII. Authorized Official

Name: MS. LINDA J OWOC
Title or Position: MANAGER THERAPIST
Credential: PT
Phone: 603-472-5546