Provider Demographics
NPI:1912199621
Name:CHAPUT, MARK R (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:CHAPUT
Suffix:
Gender:M
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:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-1828
Mailing Address - Country:US
Mailing Address - Phone:603-447-2533
Mailing Address - Fax:603-447-2544
Practice Address - Street 1:37 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6166
Practice Address - Country:US
Practice Address - Phone:603-447-2533
Practice Address - Fax:603-447-2544
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156232251X0800X
NH48092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic