Individual
JENNA L WING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
840 HAMMOND ST STE 2, BANGOR, ME 04401-4339
(207) 433-7778
(866) 220-5031
Mailing address
840 HAMMOND ST, # 2, BANGOR, ME 04401-4339
(207) 433-7778
(866) 220-5031
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3687
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932414182
ANTHEM
ME
01
—
P00871623
RR MEDICARE
ME
Enumeration date
08/12/2010
Last updated
03/15/2018
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