Individual
KEITH ELLSMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
105 MAIN ST, SOUTH PORTLAND, ME 04106-2621
(207) 741-2624
Mailing address
23 SANBORN ST, GORHAM, ME 04038-2230
(207) 449-4160
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1881
ME
Other
Enumeration date
03/08/2007
Last updated
07/08/2007
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