Provider Demographics
NPI:1851553895
Name:THERRIEN, MARI (PT, DSC, PCS)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:THERRIEN
Suffix:
Gender:F
Credentials:PT, DSC, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 LIMERICK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3506
Mailing Address - Country:US
Mailing Address - Phone:971-227-9917
Mailing Address - Fax:
Practice Address - Street 1:2213 LIMERICK DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3506
Practice Address - Country:US
Practice Address - Phone:971-227-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5545225100000X
WA60003247225100000X
PAPT0223102251P0200X
FL313732251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist