Provider Demographics
NPI:1538288196
Name:WATERMAN, MARCIA BUMSTED (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:BUMSTED
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GEORGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-4301
Mailing Address - Country:US
Mailing Address - Phone:603-632-5407
Mailing Address - Fax:
Practice Address - Street 1:249 COUNTY RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5795
Practice Address - Country:US
Practice Address - Phone:603-526-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist