Most Relevant Information
Provider Data
| NPI Number: | 1003825316 |
| Provider Name: | LINDA THERIAULT PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 694 |
Most Important Dates
| Enumeration Date: | 08/05/2006 |
| Last Updated: | 03/18/2011 |
Provider Practice Location
3300 MAIN ST
2ND FLOOR SUITE A
SPRINGFIELD
MA
011991002
Practice Location Phone/Fax
| Phone: | 4137947246 |
| Fax: | 4137940198 |
Provider Mailing Location
280 CHESTNUT ST
2ND FLOOR
SPRINGFIELD
MA
011991000
Provider Mailing Phone/Fax
| Phone: | 4137945700 |
| Fax: |