Individual
TIMOTHY P DAVOREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
33 SEWALL ST, PORTLAND, ME 04102-2603
(207) 828-2100
(207) 828-2190
Mailing address
PO BOX 1260, PORTLAND, ME 04104-1260
(207) 828-2100
(207) 828-2190
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1285
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010378502
—
ME
Enumeration date
12/01/2005
Last updated
08/26/2009
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