MEDICARE: TARDIF COMMUNITY THERAPY & WELLNESS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT532	ME

General Provider Information

NPI Number	:	1588959647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARDIF COMMUNITY THERAPY & WELLNESS PA

Provider Business Mailing Address
First Line	:	PO BOX 227
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-0227
Country	:	US
Telephone Number	:	207-862-5709
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MAIN ROAD NORTH
Second Line	:
City	:	HAMPDEN
State	:	ME
Zip	:	04444-0227
Country	:	US
Telephone Number	:	207-862-5709
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANA PAUL TARDIF
Credential	:	PT
Telephone Number	:	207-862-5709

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	08/26/2011

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