Provider Demographics
NPI:1407321763
Name:VALCOURT, ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VALCOURT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 1156
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-1156
Mailing Address - Country:US
Mailing Address - Phone:603-306-6515
Mailing Address - Fax:
Practice Address - Street 1:39 CLIPPER DR
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4222
Practice Address - Country:US
Practice Address - Phone:603-569-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1305225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant