Individual
STEPHEN RAYMOND SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
26 PORTLAND STREET, PORTLAND, ME 04101
(207) 761-8402
(207) 761-8405
Mailing address
75 WASHINGTON AVE, STE 300, PORTLAND, ME 04101-2665
(207) 761-8402
(207) 761-8405
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1506
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061343
ANTHEM
ME
Enumeration date
05/16/2007
Last updated
12/14/2017
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