Provider Demographics
NPI:1629321179
Name:FREUDENBERGER, PHIL MICHAEL JR (LMT)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:MICHAEL
Last Name:FREUDENBERGER
Suffix:JR
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 1:40 BRANDY LEE LN
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-3030
Mailing Address - Country:US
Mailing Address - Phone:603-237-8436
Mailing Address - Fax:
Practice Address - Street 1:40 BRANDY LEE LN
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-3030
Practice Address - Country:US
Practice Address - Phone:603-237-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1750M172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist