Provider Demographics
NPI:1841491909
Name:MANEGRE, THERESA MARIE (RD)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:MARIE
Last Name:MANEGRE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:ZEOGAS
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:680 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3308
Mailing Address - Country:US
Mailing Address - Phone:508-941-7000
Mailing Address - Fax:508-941-6337
Practice Address - Street 1:680 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7000
Practice Address - Fax:508-941-6337
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2529133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered