Provider Demographics
NPI:1265680342
Name:YOUNGQUIST, PAUL ERIC (LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ERIC
Last Name:YOUNGQUIST
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-2417
Mailing Address - Country:US
Mailing Address - Phone:603-547-5051
Mailing Address - Fax:603-371-0284
Practice Address - Street 1:7 MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-2417
Practice Address - Country:US
Practice Address - Phone:603-547-5051
Practice Address - Fax:603-371-0284
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1836M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist