Edward Victor Small Jr., PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PA3405 Issued in ME

Practice address

489 State St
Bangor, ME 04401-6616

Phone

(207) 973-8086

NPI assigned

Mar 13, 2013

Last updated

Mar 13, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ted Small Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1508107665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 BIRCH ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014025",
            "telephone_number": "864-979-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-8086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALL",
        "first_name": "EDWARD",
        "middle_name": "VICTOR",
        "name_suffix": "Jr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-13",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ME",
            "license": "PA3405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TED",
            "last_name": "SMALL",
            "credential": "PTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Garrick James Slate, M.D.
• Shelby J Slauenwhite, PAC
• Sleep Well Inc
• Alexandrea Sleeper
• Michelle Elizabeth Varney Slike, PT, DPT
• Elizabeth R Small, LCSW
• Jessica Demerise Small, LCPC
• Patricia Small, DO
• Smart Vision, LLC
• Mandi Lynn Smiley, CADC

• Physical Therapy Assistant in Bangor, ME
• Providers in Bangor, ME by specialty
• Physical Therapy Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.