Basic Information
| Provider Information | |||||||||
| NPI: | 1265591341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLBER | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 BERKELEY ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030641936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038836579 | ||||||||
| FaxNumber: | 6038815280 | ||||||||
| Practice Location | |||||||||
| Address1: | 522 AMHERST ST | ||||||||
| Address2: | SUITE 22 | ||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030631019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038800448 | ||||||||
| FaxNumber: | 6038815280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 926 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 30393959 | 05 | NH | MEDICAID | 0807313Y0NH01 | 01 | NH | ANTHEM | OTHER | 9571276 | 01 | NH | CIGNA | OTHER |