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General NPI Number Information
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NPI Number | 1811310485
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Entity Type | Individual
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Provider Name | JESSE JANDREAU PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/01/2014
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 78 RIDGEWOOD DR
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 207-947-8381
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Fax |
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Provider Business Mailing Address
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Address Line | 277 STATE ST STE 1B
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City | BANGOR
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State | ME
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Zip | 04401-5440
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Country | US
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Telephone | 207-922-4000
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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 | PT4152
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License Number State | ME
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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 | 1239309
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License Number State | TX
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