Individual
GLENN MACLEAN-TALBOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3177
ME
225100000X
Physical Therapist
Primary
5749
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5749
PHYSICAL THERAPY LICENSE NUMBER
OR
Enumeration date
08/19/2006
Last updated
11/13/2012
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