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Individual

PAUL SIMONSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
100 FODEN RD, WEST, SUITE 205, PORTLAND, ME 04106-2327
(207) 780-8860
(207) 780-8857
Mailing address
100 FODEN ROAD WEST, SUITE 203, SOUTH PORTLAND, ME 04106-2327
(207) 828-0361
(207) 874-1483

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT407
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
030579
ANTHEM
05
275560099
ME
01
4546206
AETNA
Enumeration date
07/11/2006
Last updated
01/04/2013
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