Individual ProviderLinda TheriaultPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3300 Main St, 2nd Floor Suite A, Springfield, MA 01199-1002(413) 794-7246(413) 794-5700PECOS EnrollmentBased on the most recent information from CMS, provider Linda Theriault is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 9 days ago.Profile DetailsProvider ID1003825316Provider TypeIndividualFull NameTheriault, LindaCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date8/5/2006Last Updated3/18/2011Contact InformationPractice LocationPractice Address3300 Main St, 2nd Floor Suite A, Springfield, MA 01199-1002Phone(413) 794-7246Fax(413) 794-0198Mailing LocationMailing Address280 Chestnut St, 2nd Floor, Springfield, MA 01199-1000Phone(413) 794-5700FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363AM0700XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense694Massachusetts