Provider Demographics
NPI:1811161656
Name:OUELLETTE, CYNTHIA QUINN (PTMEDPCS)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:QUINN
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:PTMEDPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9522
Mailing Address - Country:US
Mailing Address - Phone:413-467-1170
Mailing Address - Fax:
Practice Address - Street 1:109 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-9522
Practice Address - Country:US
Practice Address - Phone:413-467-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist