Provider Demographics
NPI:1124006234
Name:TERCIAK DONLON, LOUISE (PT)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:TERCIAK DONLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:TERCIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:915 COMMONWEALTH AVE REAR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1394
Mailing Address - Country:US
Mailing Address - Phone:617-358-3700
Mailing Address - Fax:617-358-3710
Practice Address - Street 1:915 COMMONWEALTH AVE REAR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1394
Practice Address - Country:US
Practice Address - Phone:617-358-3700
Practice Address - Fax:617-358-3710
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist