Individual
SUSAN DUMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0849
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0808117Y0NH01
ANTHEM PROVIDER NUMBER
NH
01
—
542065286
TAX IDENTIFICATION NUMBER
NH
01
—
626470
HPHC PROVIDER NUMBER
NH
Enumeration date
01/04/2007
Last updated
09/20/2011
Update your record
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