Individual
BENJAMIN WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 CENTRAL AVE, LEWISTON, ME 04240-6042
(207) 786-8257
Mailing address
130 CENTRAL AVE, LEWISTON, ME 04240-6042
(207) 786-8257
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT451
MAINE LICENSE
ME
Enumeration date
12/06/2019
Last updated
12/06/2019
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