Provider Demographics
NPI:1881681781
Name:SMITH-BLAIS, LINDA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:SMITH-BLAIS
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 1:146 PALMER ROAD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03748-4314
Mailing Address - Country:US
Mailing Address - Phone:603-632-4150
Mailing Address - Fax:603-543-3400
Practice Address - Street 1:146 PALMER ROAD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03748-4314
Practice Address - Country:US
Practice Address - Phone:603-632-4150
Practice Address - Fax:603-543-3400
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30392577Medicaid
VT1010285Medicaid
VT1010285Medicaid