Provider Demographics
NPI:1952100208
Name:BLANCHARD, LISA EILEEN (LMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:EILEEN
Last Name:BLANCHARD
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 HAMMOND RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-5112
Mailing Address - Country:US
Mailing Address - Phone:207-459-6594
Mailing Address - Fax:
Practice Address - Street 1:24 CHESTNUT ST STE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-7301
Practice Address - Country:US
Practice Address - Phone:207-459-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT6815225700000X
NH8379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist