Provider Demographics
NPI:1801807276
Name:WUEBBOLT, ELIZABETH FAVREAU (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAVREAU
Last Name:WUEBBOLT
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 1:58 BEAVER POND RD
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-5800
Mailing Address - Country:US
Mailing Address - Phone:603-529-3032
Mailing Address - Fax:603-666-6617
Practice Address - Street 1:40 S. RIVER ROAD, UNI
Practice Address - Street 2:MERRIMACK VALLEY PHYSICAL THERAPY
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-626-4205
Practice Address - Fax:603-666-6617
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH08792251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30392154Medicaid
NH30392154Medicaid