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NPI Code Detail

MEDICARE: NICOLE DENISE DESJARDINS MSPT

MEDICARE: NICOLE DENISE DESJARDINS MSPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251G0304XGeriatric Physical TherapistPT2877ME

General Provider Information

NPI Number : 1326209214
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE DENISE DESJARDINS MSPT
Provider Business Mailing Address
First Line : 18 CARON ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-6446
Country : US
Telephone Number : 207-795-6330
Fax Number :
Provider Business Practice Location Address
First Line : 440 MINOT AVE
Second Line :
City : AUBURN
State : ME
Zip : 04210-4332
Country : US
Telephone Number : 207-784-3573
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2008
Last Update Date : 06/23/2008

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Directions to “ NICOLE DENISE DESJARDINS MSPT” Practice Location

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