Provider Demographics
NPI:1003543521
Name:REDWINE, LILLIAN (DPT)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:REDWINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 PRESCOTT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04849-3425
Mailing Address - Country:US
Mailing Address - Phone:207-877-1800
Mailing Address - Fax:
Practice Address - Street 1:118 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6009
Practice Address - Country:US
Practice Address - Phone:207-505-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics