Provider Demographics
NPI:1598848152
Name:SMITH, MICHELLE ANNE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:SMITH
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 1:59 SHEFFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2314
Mailing Address - Country:US
Mailing Address - Phone:603-622-0909
Mailing Address - Fax:603-622-2869
Practice Address - Street 1:59 SHEFFIELD RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2314
Practice Address - Country:US
Practice Address - Phone:603-622-0909
Practice Address - Fax:603-622-2869
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH101135400OtherACS
NH2486344OtherAETNA
NH387946OtherMVP
NH0805561Y0NH01OtherANTHEM
NH30393788Medicaid
NH387946OtherMVP