Provider Demographics
NPI:1235333873
Name:ST. JEAN, RENEE M (PT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:ST. JEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEUROMUSCULAR REHABILITATION, PA
Mailing Address - Street 2:179 LISBON ST LOWER LOBBY SUITE 2
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7248
Mailing Address - Country:US
Mailing Address - Phone:207-753-0100
Mailing Address - Fax:207-753-0600
Practice Address - Street 1:179 LISBON ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7248
Practice Address - Country:US
Practice Address - Phone:207-753-0100
Practice Address - Fax:207-753-0600
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME265600099Medicaid
ME265600000Medicaid
MEME1130Medicare PIN
MEME1180Medicare ID - Type Unspecified