Individual
MATTHEW O'CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
45 MALLETT DR, FREEPORT, ME 04032-1312
(207) 442-0325
(207) 443-4578
Mailing address
45 MALLETT DR, FREEPORT, ME 04032-1312
(207) 442-0325
(207) 443-4578
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3496
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433275299
—
ME
Enumeration date
11/10/2008
Last updated
04/09/2012
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