Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT5065 | ME |
NPI | 1053805689 |
---|---|
Provider Name | Samantha Wood |
First Address | Cape Elizabeth, ME 04107-9501 |
Second Address | Saco, ME 04072-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |