Provider Demographics
NPI:1396055505
Name:PRUNIER, MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PRUNIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WILDERNESS ACRES RD.
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:NH
Mailing Address - Zip Code:03585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:161 WILDERNESS ACRES RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:NH
Practice Address - Zip Code:03585-3018
Practice Address - Country:US
Practice Address - Phone:603-769-1893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist