Provider Demographics
NPI:1285868091
Name:ANDERSON, JEAN DICIANCIA (PT)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:DICIANCIA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 DRAKE HILL RD.
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:ME
Mailing Address - Zip Code:04910
Mailing Address - Country:US
Mailing Address - Phone:207-437-2110
Mailing Address - Fax:
Practice Address - Street 1:200 KENNEDY MEMORIAL DRIVE
Practice Address - Street 2:REHAB WORKS DEPT.
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-861-3360
Practice Address - Fax:207-877-0897
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEP.T.750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist