Provider Demographics
NPI:1194058305
Name:DEVEAU, MICHEL E (PTA)
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:E
Last Name:DEVEAU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2110
Mailing Address - Country:US
Mailing Address - Phone:207-582-5100
Mailing Address - Fax:207-582-5100
Practice Address - Street 1:226 WATER ST
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2110
Practice Address - Country:US
Practice Address - Phone:207-582-5100
Practice Address - Fax:207-582-5100
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA3553225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant