=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356389837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY C ZIRPOLO PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2006
-----------------------------------------------------
Last Update Date | 05/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 CHRISTIAN AVE
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-6128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-229-1172
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1013
-----------------------------------------------------
City | SANBORNVILLE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03872-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-522-8215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2968
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 13231
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------