Healthcare Provider Details

I. General information

NPI: 1457495442
Provider Name (Legal Business Name): PLW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 MAIN ST BOX 11
SANFORD ME
04073-3606
US

IV. Provider business mailing address

1068 MAIN ST BOX 11
SANFORD ME
04073-3606
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-1611
  • Fax: 207-324-1611
Mailing address:
  • Phone: 207-324-1611
  • Fax: 207-324-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT874
License Number StateME

VIII. Authorized Official

Name: MS. PAMELA WINSOR
Title or Position: PRESIDENT
Credential: PT
Phone: 207-324-1611