Healthcare Provider Details

I. General information

NPI: 1811789019
Provider Name (Legal Business Name): AMANDA DOSTIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COOL ST
WATERVILLE ME
04901-5221
US

IV. Provider business mailing address

27 COOL ST
WATERVILLE ME
04901-5221
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-0721
  • Fax:
Mailing address:
  • Phone: 207-873-0721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA3970
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: