Individual
TINA LYNN FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
158 ROSS RD, KENNEBUNK, ME 04043-6532
(207) 604-7147
Mailing address
465 MAIN ST APT 103, SPRINGVALE, ME 04083-1809
(207) 608-8002
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PA3179
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA3179
PTA LICENSE
ME
Enumeration date
03/23/2007
Last updated
05/16/2008
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