Provider Demographics
NPI:1215484209
Name:BOURQUE, SARAH NATHERESE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:NATHERESE
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HANOVER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5401
Mailing Address - Country:US
Mailing Address - Phone:603-625-1864
Mailing Address - Fax:603-668-7181
Practice Address - Street 1:2165 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8809
Practice Address - Country:US
Practice Address - Phone:828-324-2800
Practice Address - Fax:828-291-9160
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4120225100000X
NCCP000371T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist