Provider Demographics
NPI:1558445098
Name:POUZOL, PHILIP R (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:POUZOL
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 1:49 FOREST KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:ORRINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04474-3323
Mailing Address - Country:US
Mailing Address - Phone:207-825-4704
Mailing Address - Fax:
Practice Address - Street 1:33B PENN PLZ
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3619
Practice Address - Country:US
Practice Address - Phone:207-990-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124440099Medicaid
ME124440099Medicaid