Provider Demographics
NPI:1134165616
Name:JUBINVILLE, DESIREE JEANNE (ATC, NHLAT)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:JEANNE
Last Name:JUBINVILLE
Suffix:
Gender:F
Credentials:ATC, NHLAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MAST RD
Mailing Address - Street 2:
Mailing Address - City:GOFFSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03045-2350
Mailing Address - Country:US
Mailing Address - Phone:603-361-2072
Mailing Address - Fax:
Practice Address - Street 1:48 MAST RD
Practice Address - Street 2:
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-2350
Practice Address - Country:US
Practice Address - Phone:603-497-8717
Practice Address - Fax:603-497-8711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer