Provider Demographics
NPI:1952909293
Name:TSOMIDES, ALEX ANTHONY
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:ANTHONY
Last Name:TSOMIDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 NEWCOMB LN APT C
Mailing Address - Street 2:
Mailing Address - City:LEVANT
Mailing Address - State:ME
Mailing Address - Zip Code:04456-4476
Mailing Address - Country:US
Mailing Address - Phone:207-205-1167
Mailing Address - Fax:
Practice Address - Street 1:601 STILLWATER AVE STE 5
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-2215
Practice Address - Country:US
Practice Address - Phone:207-817-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist