Healthcare Provider Details

I. General information

NPI: 1982639068
Provider Name (Legal Business Name): PAUL SIMONSEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD, WEST SUITE 205
PORTLAND ME
04106-2327
US

IV. Provider business mailing address

100 FODEN ROAD WEST SUITE 203
SOUTH PORTLAND ME
04106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 207-780-8860
  • Fax: 207-780-8857
Mailing address:
  • Phone: 207-828-0361
  • Fax: 207-874-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT407
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: