Provider Demographics
NPI:1235572660
Name:DESAUTELS, THERESA M (RPT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:DESAUTELS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 APPLE HILL LN
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1127
Mailing Address - Country:US
Mailing Address - Phone:781-334-5481
Mailing Address - Fax:
Practice Address - Street 1:3 APPLE HILL LN
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01940-1127
Practice Address - Country:US
Practice Address - Phone:781-334-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist