Individual
JONATHAN D OUELLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
82 SYLVAN RD, BANGOR, ME 04401-4221
(207) 401-4324
(207) 401-4325
Mailing address
82 SYLVAN RD, BANGOR, ME 04401-4221
(207) 401-4324
(207) 401-4325
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PA5982
ME
Other
Enumeration date
08/06/2021
Last updated
08/06/2021
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