Healthcare Provider Details

I. General information

NPI: 1306755459
Provider Name (Legal Business Name): JASON CHAMBERS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 US ROUTE 1 STE E
SCARBOROUGH ME
04074-9601
US

IV. Provider business mailing address

1 DINGLEY SPRING RD
GORHAM ME
04038-2202
US

V. Phone/Fax

Practice location:
  • Phone: 207-632-2585
  • Fax:
Mailing address:
  • Phone: 207-632-2585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT2210
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: