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1912038001
KEITH ELLSMORE
SOUTH PORTLAND, ME
NPI
1912038001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
(Licence: ME PT1881)
Enumeration Date
2007-03-08
Last Update Date
2007-07-08
Business Address
-- KEITH ELLSMORE P.T.
105 MAIN ST
SOUTH PORTLAND, ME 04106-2621
Phone number: 207-741-2624
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Mailing Address
-- KEITH ELLSMORE P.T.
23 SANBORN ST
GORHAM, ME 04038-2230
Phone number: 207-449-4160
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