Active NPI
Elizabeth Favreau Wuebbolt, PT
- Pediatric Physical Therapist
- Bedford, NH
National Provider Identifier
1801807276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 0879
- Practice address
- 40 S. River Road, Uni
Merrimack Valley Physical Therapy
Bedford, NH 03110 - Phone
- (603) 626-4205
- Fax
- (603) 666-6617
- NPI assigned
- Aug 11, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 0879 | NH | Primary |
Addresses
Primary practice location
40 S. River Road, Uni
Merrimack Valley Physical Therapy
Bedford, NH 03110
Mailing address
58 Beaver Pond Rd
Weare, NH 03281-5800
Phone (603) 529-3032
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30392154 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0879 | NH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801807276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 BEAVER POND RD",
"city": "WEARE",
"state": "NH",
"postal_code": "032815800",
"telephone_number": "603-529-3032",
"fax_number": "603-666-6617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 S. RIVER ROAD, UNI",
"address_2": "MERRIMACK VALLEY PHYSICAL THERAPY",
"city": "BEDFORD",
"state": "NH",
"postal_code": "03110",
"telephone_number": "603-626-4205",
"fax_number": "603-666-6617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WUEBBOLT",
"first_name": "ELIZABETH",
"middle_name": "FAVREAU",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NH",
"license": "0879",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30392154",
"state": "NH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bedford, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.