Provider Demographics
NPI:1760071674
Name:ST. GERMAIN, MICHAEL E
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:ST. GERMAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2136 BAPTIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-9602
Mailing Address - Country:US
Mailing Address - Phone:413-297-4437
Mailing Address - Fax:413-596-2311
Practice Address - Street 1:YMCA - 45 POST OFFICE PARK
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1179
Practice Address - Country:US
Practice Address - Phone:413-599-1607
Practice Address - Fax:413-596-2311
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6042225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant