Basic Information
| Provider Information | |||||||||
| NPI: | 1205071404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMERS | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 GROVE AVE | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031095044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036698561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 HARRIS ROAD | ||||||||
| Address2: | |||||||||
| City: | NASUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038881573 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2008 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0795 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.