Provider Demographics
NPI:1528627635
Name:NANTEL, ROBERT JR (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NANTEL
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-4205
Mailing Address - Country:US
Mailing Address - Phone:207-590-2405
Mailing Address - Fax:
Practice Address - Street 1:10 GOODALL DR
Practice Address - Street 2:
Practice Address - City:E WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04030-5214
Practice Address - Country:US
Practice Address - Phone:207-490-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist