Provider Demographics
NPI:1811002298
Name:SLATER, CONSTANCE (PT)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S LOWER BAY RD
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:ME
Mailing Address - Zip Code:04051-3536
Mailing Address - Country:US
Mailing Address - Phone:207-925-6803
Mailing Address - Fax:
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:BRIDGTON HOSPITAL- REHAB DEPT
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1148
Practice Address - Country:US
Practice Address - Phone:207-647-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME286170099Medicaid
ME286170099Medicaid