Provider Demographics
NPI:1851010813
Name:LETOURNEAU, MAYA CORRETTA (DPT)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:CORRETTA
Last Name:LETOURNEAU
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 1:225 GRAND ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2503
Mailing Address - Country:US
Mailing Address - Phone:323-899-5613
Mailing Address - Fax:
Practice Address - Street 1:333 E 56TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3758
Practice Address - Country:US
Practice Address - Phone:212-317-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02116300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist