Provider Demographics
NPI:1841678760
Name:BRODEUR, FELICIA (DPT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BRODEUR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 NH ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03835-3844
Mailing Address - Country:US
Mailing Address - Phone:603-839-1034
Mailing Address - Fax:603-839-1039
Practice Address - Street 1:395 NH ROUTE 11
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NH
Practice Address - Zip Code:03835-3844
Practice Address - Country:US
Practice Address - Phone:603-839-1034
Practice Address - Fax:603-839-1039
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH39712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3971OtherSTATE OF NH OFFICE OF LICENSED ALLIED HEALTH PROFESSIONALS