Provider Demographics
NPI:1245666767
Name:SMITH, GLISON ANGELA LEHTO (DPT)
Entity type:Individual
Prefix:
First Name:GLISON
Middle Name:ANGELA LEHTO
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FURBUSH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3812
Mailing Address - Country:US
Mailing Address - Phone:207-441-6189
Mailing Address - Fax:
Practice Address - Street 1:1977 LISBON RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1415
Practice Address - Country:US
Practice Address - Phone:207-784-3400
Practice Address - Fax:207-784-6400
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist