Provider Demographics
NPI:1881904076
Name:GILBERT, WILLIAM JUSTIN (PT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JUSTIN
Last Name:GILBERT
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 1:17 TIDY RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1020
Mailing Address - Country:US
Mailing Address - Phone:207-686-3034
Mailing Address - Fax:
Practice Address - Street 1:57 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:SOUTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03908-1203
Practice Address - Country:US
Practice Address - Phone:207-384-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist