Basic Information
| Provider Information | |||||||||
| NPI: | 1124006234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERCIAK DONLON | ||||||||
| FirstName: | LOUISE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TERCIAK | ||||||||
| OtherFirstName: | LOUISE | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 915 COMMONWEALTH AVE REAR | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022151394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173583700 | ||||||||
| FaxNumber: | 6173583710 | ||||||||
| Practice Location | |||||||||
| Address1: | 915 COMMONWEALTH AVE REAR | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022151394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173583700 | ||||||||
| FaxNumber: | 6173583710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 09/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 15526 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.