MEDICARE: MR. VICTOR NICKOLAS CARBONE JR. PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1207	NH

General Provider Information

NPI Number	:	1427270867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICTOR NICKOLAS CARBONE JR. PT

Provider Business Mailing Address
First Line	:	3 CAMEO CT
Second Line	:
City	:	AUBURN
State	:	NH
Zip	:	03032-3745
Country	:	US
Telephone Number	:	603-669-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 S MAIN ST
Second Line	:	SUITE 201
City	:	MANCHESTER
State	:	NH
Zip	:	03102-5166
Country	:	US
Telephone Number	:	603-641-6700
Fax Number	:	603-623-3611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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