Provider Demographics
NPI:1770551046
Name:BAILLARGEON, PATRICIA MARY (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:BAILLARGEON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARY
Other - Last Name:PIECEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6 CONROY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535
Mailing Address - Country:US
Mailing Address - Phone:617-520-7961
Mailing Address - Fax:
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2691
Practice Address - Country:US
Practice Address - Phone:774-449-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22254OtherFALLON
MA0381845Medicaid
MDY65843OtherBLUE SHIELD
MA0381845Medicaid