Provider Demographics
NPI:1245536622
Name:THIBEAULT, LEA ROSEMARIE (MASSAGE THERIPAST)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ROSEMARIE
Last Name:THIBEAULT
Suffix:
Gender:F
Credentials:MASSAGE THERIPAST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 S CHURCH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7605
Mailing Address - Country:US
Mailing Address - Phone:570-497-4766
Mailing Address - Fax:570-245-3899
Practice Address - Street 1:305 S CHURCH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7605
Practice Address - Country:US
Practice Address - Phone:570-497-4766
Practice Address - Fax:570-245-3899
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist