Individual
LISA ROSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4 COMMONS AVE STE A, WINDHAM, ME 04062-5554
(207) 893-1738
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT6034
ME
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669149167
—
ME
Enumeration date
08/24/2021
Last updated
09/08/2021
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