Provider Demographics
NPI:1982135877
Name:MERCIER, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:MERCIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 GENERAL ELECTRIC RD
Mailing Address - Street 2:APT 17
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-3425
Mailing Address - Country:US
Mailing Address - Phone:802-734-9040
Mailing Address - Fax:
Practice Address - Street 1:4 HARBOR RIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7849
Practice Address - Country:US
Practice Address - Phone:802-734-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960042862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer