Healthcare Provider Details

I. General information

NPI: 1851880603
Provider Name (Legal Business Name): DBA CENTRAL MAINE CONDITIONING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BELGRADE AVE SUITE A
AUBURN ME
04210
US

IV. Provider business mailing address

30 BELGRADE AVE SUITE A
AUBURN ME
04210
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-0018
  • Fax: 207-783-0019
Mailing address:
  • Phone: 207-783-0018
  • Fax: 207-783-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT5586
License Number StateME

VIII. Authorized Official

Name: MS. KERSTEN ANNE CURTIS
Title or Position: HEAD LMT
Credential: LMT
Phone: 207-783-0018