Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT228 | ME |
NPI | 1053682419 |
---|---|
Provider Name | Mrs. Vicki Belinda Vadas |
First Address | Gray, ME 04039-9581 |
Second Address | Portland, ME 04103-3711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2012 |
Last Update Date | 17/01/2012 |