Provider Demographics
NPI:1114713906
Name:MORNEAULT, GWYNDOLYN E (LMT)
Entity type:Individual
Prefix:
First Name:GWYNDOLYN
Middle Name:E
Last Name:MORNEAULT
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BOOTH ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-4106
Mailing Address - Country:US
Mailing Address - Phone:207-949-4570
Mailing Address - Fax:
Practice Address - Street 1:21 DAIGLE LN STE 101
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3939
Practice Address - Country:US
Practice Address - Phone:207-558-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT7970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist