Individual
THERESA WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
890 HAMMOND ST, BANGOR, ME 04401-4328
(207) 992-4042
Mailing address
890 HAMMOND ST, BANGOR, ME 04401-4328
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3077
ME
Other
Enumeration date
01/24/2008
Last updated
01/24/2008
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