Provider Demographics
NPI:1992905343
Name:FAIN, THERESE Y (PT)
Entity type:Individual
Prefix:MRS
First Name:THERESE
Middle Name:Y
Last Name:FAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:THERESE
Other - Middle Name:E
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4818 ATTLEBORO ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5043
Mailing Address - Country:US
Mailing Address - Phone:904-483-6289
Mailing Address - Fax:904-221-5650
Practice Address - Street 1:4818 ATTLEBORO ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5043
Practice Address - Country:US
Practice Address - Phone:904-483-6289
Practice Address - Fax:904-221-5650
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT201562251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics