Lakeside Physical Therapy & Fitness Center

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1953 Issued in NH

Legal business name

LAKESIDE PHYSICAL THERAPY & FITNESS CENTER

Practice address

685 White Mountain Hwy
Tamworth, NH 03886-4638

Phone

(603) 323-2089

Fax

(603) 323-2097

NPI assigned

Jul 26, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jack Tomasz Hadam, DPTNPI 1063594950

Title

President

Phone

(603) 323-2089

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

Tax ID family

Lakeside Physical Therapy and Fitness CT2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lakeside Physical Therapy & Fitness Center

  • Physical Therapy Clinic/Center
  • Tamworth, NH
  • NPI 1396984670
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Tomasz Hadam, DPT

  • Legal Medicine
  • Tamworth, NH
  • NPI 1063594950
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1386957843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 WHITE MOUNTAIN HWY",
            "city": "TAMWORTH",
            "state": "NH",
            "postal_code": "038864638",
            "telephone_number": "603-323-2089",
            "fax_number": "603-323-2097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "685 WHITE MOUNTAIN HWY",
            "city": "TAMWORTH",
            "state": "NH",
            "postal_code": "038864638",
            "telephone_number": "603-323-2089",
            "fax_number": "603-323-2097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 White Mountain Hwy",
            "address_purpose": "LOCATION",
            "city": "Tamworth",
            "state": "NH",
            "postal_code": "038864625",
            "country_code": "US",
            "telephone_number": "603-323-2089",
            "fax_number": "603-323-2097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKESIDE PHYSICAL THERAPY & FITNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-26",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "HADAM",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "TOMASZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "603-323-2089",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "1953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annemarie E Green, LMT,CMT
• Jack Tomasz Hadam, DPT
• Mary Kathleen Hanson, OTR/L
• Huggins Hospital
• Brian R Irwin, D.O.
• Lakeside Physical Therapy & Fitness Center
• Lakeview Community Services
• Nancy Sheridan, MSW
• Sheryl Lynn Power, LICSW
• Erika Birch Rezzuti, ABOC

• Physical Therapist in Tamworth, NH
• Providers in Tamworth, NH by specialty
• Physical Therapist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.