Provider Demographics
NPI:1740231141
Name:ALLAIN, MICHAEL W (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:ALLAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SOUTH RIVER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6759
Mailing Address - Country:US
Mailing Address - Phone:603-518-5290
Mailing Address - Fax:603-218-6804
Practice Address - Street 1:72 S RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6759
Practice Address - Country:US
Practice Address - Phone:603-518-5290
Practice Address - Fax:603-218-6804
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO8498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA066600Medicare Oscar/Certification
CO805028Medicare PIN
CO805017Medicare PIN