Healthcare Provider Details

I. General information

NPI: 1417720418
Provider Name (Legal Business Name): GINA FRENCH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA CORREIA

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 STEVENS AVE
PORTLAND ME
04103-3068
US

IV. Provider business mailing address

161 FOREST ST
WESTBROOK ME
04092-4342
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-5868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT7085
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: