Provider Demographics
NPI:1225039266
Name:MEDEIROS, JOSEPH F (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:MEDEIROS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 PARMENTER ROAD
Mailing Address - Street 2:UNIT C7
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-434-6592
Mailing Address - Fax:603-437-6533
Practice Address - Street 1:2 PARMENTER ROAD
Practice Address - Street 2:UNIT C7
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-434-6592
Practice Address - Fax:603-437-6533
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30392144Medicaid
NHRE5170Medicare ID - Type Unspecified