Provider Demographics
NPI:1285694448
Name:SIROIS, MICHAEL A (MS, L-ATC, PES)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:SIROIS
Suffix:
Gender:M
Credentials:MS, L-ATC, PES
Other - Prefix:
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Mailing Address - Street 1:100 SAINT ANSELMS DR
Mailing Address - Street 2:BOX 1727
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-1308
Mailing Address - Country:US
Mailing Address - Phone:603-641-7807
Mailing Address - Fax:603-222-4091
Practice Address - Street 1:100 SAINT ANSELMS DR
Practice Address - Street 2:BOX 1727
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-1308
Practice Address - Country:US
Practice Address - Phone:603-641-7807
Practice Address - Fax:603-222-4091
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH02762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer