Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT1872 | ME |
NPI | 1043569791 |
---|---|
Provider Name | Michael A Rich |
First Address | Cmaden, ME 04843-1920 |
Second Address | Rockland, ME 04841-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2012 |
Last Update Date | 09/09/2012 |