Provider Demographics
NPI:1326457300
Name:THERRIAULT, MARIA LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LYNN
Last Name:THERRIAULT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1604
Mailing Address - Country:US
Mailing Address - Phone:603-466-5972
Mailing Address - Fax:
Practice Address - Street 1:40 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1604
Practice Address - Country:US
Practice Address - Phone:603-466-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1004225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant