Provider Demographics
NPI:1487764197
Name:DUBOIS, KIMBERLY M (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PREVITI DUBOIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:40 S RIVER RD
Mailing Address - Street 2:BEDFORD PLACE, UNIT 58
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6719
Mailing Address - Country:US
Mailing Address - Phone:603-626-4205
Mailing Address - Fax:603-666-6617
Practice Address - Street 1:40 S RIVER RD
Practice Address - Street 2:BEDFORD PLACE, UNIT 58
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6719
Practice Address - Country:US
Practice Address - Phone:603-626-4205
Practice Address - Fax:603-666-6617
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3159225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3159OtherPT LICENSE