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General NPI Number Information
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NPI Number | 1942284054
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Entity Type | Individual
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Provider Name | MR. STEPHEN V BECKETT
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 222 SAINT JOHN ST STE 137
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City | PORTLAND
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State | ME
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Zip | 04102-3024
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Country | US
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Telephone | 207-772-3800
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Fax | 207-774-3510
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Provider Business Mailing Address
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Address Line | 222 SAINT JOHN ST STE 137
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City | PORTLAND
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State | ME
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Zip | 04102-3024
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Country | US
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Telephone | 207-772-3800
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Fax | 207-774-3510
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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 | PT2100
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License Number State | ME
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