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General NPI Number Information
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NPI Number | 1730532177
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Entity Type | Individual
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Provider Name | MICHAEL A. JEANFAVRE
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Gender | Male
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 607 BANTAM RD UNIT H
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City | BANTAM
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State | CT
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Zip | 06750-1634
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Country | US
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Telephone | 860-567-7787
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Fax | 860-567-7779
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Provider Business Mailing Address
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Address Line | 73 NEWTON RD STE 101
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City | PLAISTOW
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State | NH
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Zip | 03865-2424
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Country | US
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Telephone | 978-388-7272
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Fax | 978-388-7373
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10999
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License Number State | CT
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