MEDICARE: BRENT C THERRIEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3713	NH

General Provider Information

NPI Number	:	1326309667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT C THERRIEN

Provider Business Mailing Address
First Line	:	110 HAVERHILL RD
Second Line	:	STE 524
City	:	AMESBURY
State	:	MA
Zip	:	01913-2123
Country	:	US
Telephone Number	:	978-388-7272
Fax Number	:	978-388-7373

Provider Business Practice Location Address
First Line	:	920 LAFAYETTE RD
Second Line	:	UNIT 2
City	:	SEABROOK
State	:	NH
Zip	:	03874-4216
Country	:	US
Telephone Number	:	603-474-2259
Fax Number	:	603-474-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2012
Last Update Date	:	06/04/2012

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Directions to “ BRENT C THERRIEN ” Practice Location

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