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General NPI Number Information
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NPI Number | 1649151580
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Entity Type | Individual
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Provider Name | PRESTON REDWINE LMT
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Gender | Male
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 17 LINCOLN ST STE 16
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City | BIDDEFORD
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State | ME
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Zip | 04005-4633
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Country | US
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Telephone | 207-494-4695
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Fax |
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Provider Business Mailing Address
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Address Line | 251 ALFRED ST APT 2
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City | BIDDEFORD
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State | ME
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Zip | 04005-3267
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Country | US
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Telephone | 207-494-4695
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT7190
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License Number State | ME
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