Provider Demographics
NPI:1043210875
Name:VANCE, STEPHEN R (PT, CHT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:VANCE
Suffix:
Gender:M
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BATH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2671
Mailing Address - Country:US
Mailing Address - Phone:207-729-4998
Mailing Address - Fax:207-729-6225
Practice Address - Street 1:275 BATH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2671
Practice Address - Country:US
Practice Address - Phone:207-729-4998
Practice Address - Fax:207-729-6225
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098420OtherANTHEM
ME098420OtherANTHEM