Provider Demographics
NPI:1467816777
Name:TREMBLAY, NANCY DIANE (PTA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DIANE
Last Name:TREMBLAY
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 1:72 WALES RD
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4142
Mailing Address - Country:US
Mailing Address - Phone:207-212-2710
Mailing Address - Fax:
Practice Address - Street 1:72 WALES RD
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4142
Practice Address - Country:US
Practice Address - Phone:207-212-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3861225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant