Provider Demographics
NPI:1780204172
Name:VINAL, ELIZABETH L (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:VINAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 BEMIS RD APT 1B
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:ME
Mailing Address - Zip Code:04419-3050
Mailing Address - Country:US
Mailing Address - Phone:207-659-2105
Mailing Address - Fax:
Practice Address - Street 1:74 PARKWAY S
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1628
Practice Address - Country:US
Practice Address - Phone:207-989-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA4948225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant