Provider Demographics
NPI:1790211407
Name:MANSUR, AARON JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:JOSEPH
Last Name:MANSUR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-4138
Mailing Address - Country:US
Mailing Address - Phone:207-290-0928
Mailing Address - Fax:
Practice Address - Street 1:35105 KENAI SPUR HWY STE A
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7658
Practice Address - Country:US
Practice Address - Phone:907-260-7444
Practice Address - Fax:907-260-7400
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16743225100000X
SC8857225100000X
AK120724225100000X
VA2305210789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist