Individual
EDWARD VICTOR SMALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
489 STATE ST, BANGOR, ME 04401-6616
(207) 973-8086
Mailing address
297 BIRCH ST, BANGOR, ME 04401-4025
(864) 979-8976
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PA3405
ME
Other
Enumeration date
03/13/2013
Last updated
03/13/2013
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