Provider Demographics
NPI:1982677282
Name:FURBUSH, ANITA LOUISE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LOUISE
Last Name:FURBUSH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:LOUISE
Other - Last Name:DELZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:HOLDERNESS
Mailing Address - State:NH
Mailing Address - Zip Code:03245-0697
Mailing Address - Country:US
Mailing Address - Phone:603-536-3243
Mailing Address - Fax:
Practice Address - Street 1:15 TOWN WEST RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-536-2941
Practice Address - Fax:603-536-2949
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393654Medicaid
NH30393654Medicaid
NHRE8269Medicare ID - Type Unspecified