Healthcare Provider Details

I. General information

NPI: 1992320691
Provider Name (Legal Business Name): BROOKE FORTIER COURNOYER MSPT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 TAYLOR WAY
SANBORNVILLE NH
03872-4350
US

IV. Provider business mailing address

150 WAKEFIELD ST
ROCHESTER NH
03867-1300
US

V. Phone/Fax

Practice location:
  • Phone: 603-522-8891
  • Fax:
Mailing address:
  • Phone: 603-767-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3099
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: