Healthcare Provider Details

I. General information

NPI: 1528983566
Provider Name (Legal Business Name): ANDREW GENDREAU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 ROOSEVELT TRL UNIT 2
WINDHAM ME
04062-4983
US

IV. Provider business mailing address

20 NORWAY DR
HAMPDEN ME
04444-3023
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: