Provider Demographics
NPI:1437275245
Name:COULOMBE, REGGIE L (PT)
Entity type:Individual
Prefix:MR
First Name:REGGIE
Middle Name:L
Last Name:COULOMBE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 HOWLAND ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-3613
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1500
Practice Address - Country:US
Practice Address - Phone:603-466-5972
Practice Address - Fax:603-466-5974
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30392412Medicaid
NH1004237OtherANTHEM BLUE CROSS
NH5440890OtherHEALTHCARE VALUE MANAGEME
NH57401OtherGENESIS REHAB CIGNA
NHAA63614OtherHARVARD PILGRIM