Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1396352548 |
---|---|
Provider Name | Matthew Vachon |
First Address | Lewiston, ME 04240-5941 |
Second Address | Lewiston, ME 04240-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2020 |
Last Update Date | 30/09/2020 |