Individual
BRENT THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
3149 CHESTER AVE, BETHLEHEM, PA 18020-2866
(609) 350-5998
Mailing address
15 HAY RD, LITTLE EGG HARBOR TWP, NJ 08087-4106
(609) 350-5998
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
25MT00245400
NJ
2255A2300X
Athletic Trainer
Primary
RT007713
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T33690967108945
ATHLETIC TRAINER
NJ
Enumeration date
06/04/2021
Last updated
06/04/2021
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