Provider Demographics
NPI:1669829842
Name:CORMIER, VALERIE V (PTA)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:V
Last Name:CORMIER
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 1:460 MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1014
Mailing Address - Country:US
Mailing Address - Phone:207-728-7778
Mailing Address - Fax:207-728-7779
Practice Address - Street 1:460 MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1014
Practice Address - Country:US
Practice Address - Phone:207-728-7778
Practice Address - Fax:207-728-7779
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4224225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant