Healthcare Provider Details

I. General information

NPI: 1801454863
Provider Name (Legal Business Name): JOSHUA STETSON ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MARIE ST
WINSLOW ME
04901-7255
US

IV. Provider business mailing address

28 MARIE ST
WINSLOW ME
04901-7255
US

V. Phone/Fax

Practice location:
  • Phone: 207-432-7546
  • Fax:
Mailing address:
  • Phone: 207-432-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT789
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: