Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT4914 | ME |
NPI | 1003306556 |
---|---|
Provider Name | Sarah Mclintock |
First Address | Lewiston, ME 04240-7637 |
Second Address | Lewiston, ME 04240-7637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 10/05/2018 |