Provider Demographics
NPI:1972822807
Name:THEROUX, LISA MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:THEROUX
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 1:90 EASTERN AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6644
Mailing Address - Country:US
Mailing Address - Phone:603-935-8880
Mailing Address - Fax:
Practice Address - Street 1:124 HALL ST
Practice Address - Street 2:SUITE H
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3478
Practice Address - Country:US
Practice Address - Phone:603-224-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist