Provider Demographics
NPI:1023002243
Name:BOURDON, THOMAS STEPHEN (ATC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STEPHEN
Last Name:BOURDON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 ANDROSCOGGIN AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6606
Mailing Address - Country:US
Mailing Address - Phone:207-671-5016
Mailing Address - Fax:
Practice Address - Street 1:190 BIRCH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6408
Practice Address - Country:US
Practice Address - Phone:207-333-3236
Practice Address - Fax:207-783-3347
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEATC1852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer