Provider Demographics
NPI:1518253756
Name:POWELL, SAMUEL WILLIAM (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WILLIAM
Last Name:POWELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 CAMDEN ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2421
Mailing Address - Country:US
Mailing Address - Phone:207-593-6682
Mailing Address - Fax:207-213-1075
Practice Address - Street 1:91 CAMDEN ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2421
Practice Address - Country:US
Practice Address - Phone:207-593-6682
Practice Address - Fax:207-213-1075
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO112742251X0800X
MEPT 40132251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic