Provider Demographics
NPI:1235973629
Name:ST.HILAIRE, GABRIELLE (PTA)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:ST.HILAIRE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:
Other - Last Name:ST.HILAIRE-BERNIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:193 COOK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5377
Mailing Address - Country:US
Mailing Address - Phone:207-402-5147
Mailing Address - Fax:
Practice Address - Street 1:160 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4162
Practice Address - Country:US
Practice Address - Phone:207-622-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA6022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant