Provider Demographics
NPI:1356300610
Name:STIHILAIRE, JENNIFER (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STIHILAIRE
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 1:582 MT PISGAH RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364
Mailing Address - Country:US
Mailing Address - Phone:207-377-8034
Mailing Address - Fax:
Practice Address - Street 1:RT 7 MOOSEHEAD TRAIL
Practice Address - Street 2:PROFESSIONAL BLDG
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953
Practice Address - Country:US
Practice Address - Phone:207-368-5942
Practice Address - Fax:207-368-5951
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1578225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
206513Medicare ID - Type Unspecified