Provider Demographics
NPI:1659601029
Name:DECOTEAU, LEA S (MSPT)
Entity Type:Individual
Prefix:MS
First Name:LEA
Middle Name:S
Last Name:DECOTEAU
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POST OFFICE SQ
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3948
Mailing Address - Country:US
Mailing Address - Phone:978-881-0090
Mailing Address - Fax:978-881-0091
Practice Address - Street 1:8 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3948
Practice Address - Country:US
Practice Address - Phone:978-881-0090
Practice Address - Fax:978-881-0091
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic