Individual
MR. JUSTIN LEE BROUSSEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
183 MAIN ST, LEWISTON, ME 04240-7016
(207) 344-8385
Mailing address
183 MAIN ST, LEWISTON, ME 04240-7016
(207) 344-8385
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT4322
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT4322
MASSAGE THERAPIST
ME
Enumeration date
11/22/2010
Last updated
09/19/2012
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