Provider Demographics
NPI:1093254211
Name:FECTEAU, MICHELLE (PT, MTC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FECTEAU
Suffix:
Gender:F
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 RANGE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2026
Mailing Address - Country:US
Mailing Address - Phone:603-890-8844
Mailing Address - Fax:
Practice Address - Street 1:58 RANGE RD STE 16
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2026
Practice Address - Country:US
Practice Address - Phone:603-890-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist