Provider Demographics
NPI:1235322561
Name:THIBEAULT, GREGORY EVAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EVAN
Last Name:THIBEAULT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:YORK HOSPITAL
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-351-2143
Mailing Address - Fax:207-351-2143
Practice Address - Street 1:112 SANFOR ROAD (RT. 109)
Practice Address - Street 2:WELLS PHYSICAL THERAPY
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090
Practice Address - Country:US
Practice Address - Phone:207-646-0373
Practice Address - Fax:207-646-0381
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPT758225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist