Healthcare Provider Details

I. General information

NPI: 1346344793
Provider Name (Legal Business Name): DOCKSIDE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAIN STREET
BELGRADE LAKES ME
04918-0343
US

IV. Provider business mailing address

PO BOX 343
BELGRADE LAKES ME
04918-0343
US

V. Phone/Fax

Practice location:
  • Phone: 207-495-3195
  • Fax: 207-512-2545
Mailing address:
  • Phone: 207-495-3195
  • Fax: 207-512-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2624
License Number StateME

VIII. Authorized Official

Name: MR. MARCEL PAUL SCHNEE
Title or Position: PRESIDENT
Credential: PT
Phone: 207-495-3195