Provider Demographics
NPI:1194190348
Name:BISSAILLON, MADELINE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:BISSAILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1432
Mailing Address - Country:US
Mailing Address - Phone:603-557-9680
Mailing Address - Fax:
Practice Address - Street 1:45 DANVILLE RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03826-2451
Practice Address - Country:US
Practice Address - Phone:603-382-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-13
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist