Provider Demographics
NPI:1508294422
Name:LESIEUR, CAROLYN MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:LESIEUR
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 1:104 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:02367-1613
Mailing Address - Country:US
Mailing Address - Phone:781-585-5687
Mailing Address - Fax:
Practice Address - Street 1:17 CHIPMAN WAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1039
Practice Address - Country:US
Practice Address - Phone:781-585-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant