Provider Demographics
NPI:1861604894
Name:PLOURDE, SCOTT RICHARD (MPT, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:RICHARD
Last Name:PLOURDE
Suffix:
Gender:M
Credentials:MPT, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3609
Mailing Address - Country:US
Mailing Address - Phone:603-647-3145
Mailing Address - Fax:
Practice Address - Street 1:435 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3609
Practice Address - Country:US
Practice Address - Phone:603-647-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2495225100000X
NH2662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer