Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT4084 | ME |
NPI | 1003241167 |
---|---|
Provider Name | Ms. Kimberly Ann Bilodeau |
First Address | South Portland, ME 04106-5900 |
Second Address | South Portland, ME 04106-2327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2013 |
Last Update Date | 25/07/2017 |