1487892162 NPI number — MRS. PAULINE D. ARCHAMBAULT PT, MPT

Table of content: MRS. PAULINE D. ARCHAMBAULT PT, MPT (NPI 1487892162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487892162 NPI number — MRS. PAULINE D. ARCHAMBAULT PT, MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARCHAMBAULT
Provider First Name:
PAULINE
Provider Middle Name:
D.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487892162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 LINWOOD DRIVE
Provider Second Line Business Mailing Address:
PO BOX 1592
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03809-1592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-875-0618
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 LEHNER STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
WOLFEBORO
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-569-7972
Provider Business Practice Location Address Fax Number:
603-569-7973
Provider Enumeration Date:
02/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2668 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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