Provider Demographics
NPI:1780015149
Name:PARISEAU, GRACE ANN (LMT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:PARISEAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6104
Mailing Address - Country:US
Mailing Address - Phone:207-615-7535
Mailing Address - Fax:
Practice Address - Street 1:256 ROUTE 1
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1399
Practice Address - Country:US
Practice Address - Phone:207-615-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT 1141225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist