Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1254 | ME |
NPI | 1003283086 |
---|---|
Provider Name | Wendy Claveau |
First Address | Augusta, ME 04330-7997 |
Second Address | Augusta, ME 04330-7997 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 26/08/2015 |