Provider Demographics
NPI:1861518540
Name:BOISVERT, JAMIE (PTA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BOISVERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:PIGEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:497 HOOKSETT RD
Mailing Address - Street 2:#2 PMB 192
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 PARKHURST RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1513
Practice Address - Country:US
Practice Address - Phone:978-256-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3950225200000X
NH0819225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant