Individual
LISA FAVREAU
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
100 FODEN RD, SUITE 103W, SO PORTLAND, ME 04106-2319
(207) 772-2625
(207) 879-4246
Mailing address
100 FODEN RD, SUITE 103W, SO PORTLAND, ME 04106-2319
(207) 772-2625
(207) 879-4246
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT263
ME
Other
Enumeration date
06/19/2006
Last updated
07/08/2007
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