Provider Demographics
NPI:1265594139
Name:CORREDOR, JAVIER A (DPT)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:A
Last Name:CORREDOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ASHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 SUNDIAL AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-7230
Practice Address - Country:US
Practice Address - Phone:603-296-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME099268OtherANTHEM MAINE
NH08Y011351NH01OtherANTHEM INDIV #
NH30394987Medicaid
NHRE8968OtherMEDICARE GROUP #
AA79032OtherHARVARD PILGRIM GROUP #
NH08Y011351NH01OtherANTHEM INDIV #