Provider Demographics
NPI:1043540883
Name:THIBODEAU, ELIZABETH J
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:THIBODEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:184 LINCOLN STREET
Mailing Address - Street 2:UNIT C
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:508-565-3430
Mailing Address - Fax:508-565-3432
Practice Address - Street 1:21 BRISTOL DRIVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375
Practice Address - Country:US
Practice Address - Phone:508-565-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist