Provider Demographics
NPI:1467648196
Name:RACETTE, MARY ANN THERESA (PT)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:THERESA
Last Name:RACETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 E MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-4418
Mailing Address - Country:US
Mailing Address - Phone:413-663-5749
Mailing Address - Fax:
Practice Address - Street 1:71 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-664-5449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist