Provider Demographics
NPI:1790795714
Name:BRONSON, LOUANN (PT)
Entity type:Individual
Prefix:
First Name:LOUANN
Middle Name:
Last Name:BRONSON
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 1:73 NEWTON RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2440
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:51 WEBB PL STE 320
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2463
Practice Address - Country:US
Practice Address - Phone:603-580-4494
Practice Address - Fax:603-580-4495
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30392313Medicaid
NH08Y003908NH01OtherANTHEM
NHS203121OtherCIGNA
NH08Y003908NH01OtherANTHEM