Provider Demographics
NPI:1326309667
Name:THERRIEN, BRENT C
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:C
Last Name:THERRIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD
Mailing Address - Street 2:STE 524
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:920 LAFAYETTE RD
Practice Address - Street 2:UNIT 2
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4216
Practice Address - Country:US
Practice Address - Phone:603-474-2259
Practice Address - Fax:603-474-2253
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist