1750486064 NPI number — MS. NICOLE C MCMANUS PT

Table of content: MS. NICOLE C MCMANUS PT (NPI 1750486064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750486064 NPI number — MS. NICOLE C MCMANUS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMANUS
Provider First Name:
NICOLE
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1750486064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 ROUTE 236
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
KITTERY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
03904-6000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-439-2675
Provider Business Mailing Address Fax Number:
207-439-4965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
475 HIGH ST
Provider Second Line Business Practice Location Address:
UNIT E
Provider Business Practice Location Address City Name:
SOMERSWORTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03878-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-617-3846
Provider Business Practice Location Address Fax Number:
603-617-3848
Provider Enumeration Date:
09/13/2006

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:  17593 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 3273 , 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)