Provider Demographics
NPI:1871731596
Name:ST.JACQUES, GERARD EMERY (MSPT)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:EMERY
Last Name:ST.JACQUES
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ENDICOTT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2706
Mailing Address - Country:US
Mailing Address - Phone:508-965-0496
Mailing Address - Fax:401-232-2471
Practice Address - Street 1:6 ENDICOTT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-2706
Practice Address - Country:US
Practice Address - Phone:508-965-0496
Practice Address - Fax:401-232-2471
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16801225100000X
RIPT02059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist