Provider Demographics
NPI:1467152231
Name:ATWATER, JAROM (PT)
Entity Type:Individual
Prefix:
First Name:JAROM
Middle Name:
Last Name:ATWATER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PASSACONAWAY RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04088-3506
Mailing Address - Country:US
Mailing Address - Phone:207-595-5986
Mailing Address - Fax:
Practice Address - Street 1:175 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4254
Practice Address - Country:US
Practice Address - Phone:207-595-5986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist