Provider Demographics
NPI:1669567533
Name:COMPAGNONE, ERICA (PT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:COMPAGNONE
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 1:293 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2040
Mailing Address - Country:US
Mailing Address - Phone:603-974-0814
Mailing Address - Fax:
Practice Address - Street 1:176 WALKER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3126
Practice Address - Country:US
Practice Address - Phone:978-452-9252
Practice Address - Fax:978-970-0271
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468999OtherTUFTS PROVIDER ID
MAY68404OtherBLUE CROSS PROVIDER ID
MA2283403OtherFIRST HEALTH PROVIDER ID
MA468999OtherTUFTS PROVIDER ID