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General NPI Number Information
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NPI Number | 1134137490
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Entity Type | Organization
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Legal Business Name | WAKELAND PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 248 STATE ST SUITE 3A
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City | ELLSWORTH
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State | ME
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Zip | 04605-1850
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Country | US
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Telephone | 207-667-4278
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Fax | 207-667-4279
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Provider Business Mailing Address
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Address Line | 248 STATE STREET SUITE 3A
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City | ELLSWORTH
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State | ME
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Zip | 04605
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Country | US
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Telephone | 207-667-4278
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Fax | 207-667-4279
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. TIMOTHY LEE WAKELAND
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Credential | PT, DPT
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Telephone | 207-667-4278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT 1167
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License Number State | ME
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