MEDICARE: SHARON SAMSON STONE PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT010242	GA
2	225100000X	Physical Therapist	PT4211	ME

General Provider Information

NPI Number	:	1558659664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON SAMSON STONE PT, DPT

Provider Business Mailing Address
First Line	:	85 WESTERN AVE
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2423
Country	:	US
Telephone Number	:	207-774-7751
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 WESTERN AVE
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2423
Country	:	US
Telephone Number	:	207-774-7751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	05/05/2016

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