Healthcare Provider Details

I. General information

NPI: 1598189565
Provider Name (Legal Business Name): JEAN SMAIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD SUITE 200
SOUTH PORTLAND ME
04106-2327
US

IV. Provider business mailing address

100 FODEN RD SUITE 203
SOUTH PORTLAND ME
04106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 207-523-8500
  • Fax: 207-523-8591
Mailing address:
  • Phone: 207-828-0361
  • Fax: 207-874-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT1478
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: