Provider Demographics
NPI:1245421387
Name:LETOURNEAU, DAVID TERRY (LATC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TERRY
Last Name:LETOURNEAU
Suffix:
Gender:M
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RUSS STREET
Mailing Address - Street 2:CENTER FOR INTEGRATED NEURO-REHAB
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736
Mailing Address - Country:US
Mailing Address - Phone:207-498-3820
Mailing Address - Fax:207-498-3591
Practice Address - Street 1:7 RUSS STREET
Practice Address - Street 2:CENTER FOR INTEGRATED NEURO-REHAB
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736
Practice Address - Country:US
Practice Address - Phone:207-498-3820
Practice Address - Fax:207-498-3591
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT1532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer