Provider Demographics
NPI:1811130396
Name:ACHORN, DENISE LOUISE (PTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LOUISE
Last Name:ACHORN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:LOUISE
Other - Last Name:GOULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2 WILLIAMS STREET
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:512-970-7463
Mailing Address - Fax:
Practice Address - Street 1:2 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:512-970-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2310225200000X
TX2040657225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant