Healthcare Provider Details

I. General information

NPI: 1154558492
Provider Name (Legal Business Name): HOME ADVANTAGE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2009
Last Update Date: 06/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD TOWN RD
WEARE NH
03281-5925
US

IV. Provider business mailing address

140 OLD TOWN RD
WEARE NH
03281-5925
US

V. Phone/Fax

Practice location:
  • Phone: 603-384-3966
  • Fax:
Mailing address:
  • Phone: 603-384-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2921
License Number StateNH

VIII. Authorized Official

Name: MR. JASON JAMES COLE
Title or Position: PHYSICAL THERAPIST
Credential: D.P.T.
Phone: 603-384-3966