Provider Demographics
NPI:1659017143
Name:ST PIERRE, THERESA ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:ANN
Last Name:ST PIERRE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEAL TER
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-1107
Mailing Address - Country:US
Mailing Address - Phone:401-999-3995
Mailing Address - Fax:
Practice Address - Street 1:2974 E MAIN RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-4232
Practice Address - Country:US
Practice Address - Phone:401-293-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT025862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics