Provider Demographics
NPI:1134245285
Name:LAREAU, MARK THOMAS (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:THOMAS
Last Name:LAREAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2240
Mailing Address - Country:US
Mailing Address - Phone:508-238-9694
Mailing Address - Fax:
Practice Address - Street 1:118 SUMMER ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-2240
Practice Address - Country:US
Practice Address - Phone:508-238-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45712251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary