Individual
JUNE C DESTEFANO TAIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT940
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013890
ANTHEM
ME
05
—
278030099
—
ME
01
—
650009113
RR MEDICARE
ME
01
—
QX9576
MEDICARE PTAN
—
Enumeration date
12/08/2006
Last updated
05/14/2013
Update your record
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