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General NPI Number Information
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NPI Number | 1497265219
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Entity Type | Individual
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Provider Name | GRACE ELISABETH BEDARD
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Gender | Female
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 100 FORE ST FL 2
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City | PORTLAND
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State | ME
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Zip | 04101-4879
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Country | US
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Telephone | 207-773-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 131 COOPER HILL RD
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City | NOTTINGHAM
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State | NH
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Zip | 03290-6015
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10514
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT4644
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License Number State | ME
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