Provider Demographics
NPI:1770014821
Name:NAHORNIAK, MAUREEN THERESA (DPT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:THERESA
Last Name:NAHORNIAK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-2437
Mailing Address - Country:US
Mailing Address - Phone:413-575-7422
Mailing Address - Fax:
Practice Address - Street 1:516 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2330
Practice Address - Country:US
Practice Address - Phone:413-736-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist