Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT2848 | ME |
N | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1164074779 |
---|---|
Provider Name | William P Anderson III |
First Address | Portland, ME 04101-2442 |
Second Address | Scarborough, ME 04074-9057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2019 |
Last Update Date | 14/12/2019 |