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NPI Code Detail

MEDICARE: JULIE CATHERINE PETTIT-LANE DPT

MEDICARE:   JULIE CATHERINE PETTIT-LANE  DPT
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
1225100000XPhysical TherapistPT5950ME

General Provider Information

NPI Number : 1770996415
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE CATHERINE PETTIT-LANE DPT
Provider Business Mailing Address
First Line : 10 CHRISTY WAY
Second Line :
City : WESTBROOK
State : ME
Zip : 04092-2340
Country : US
Telephone Number : 630-561-8282
Fax Number :
Provider Business Practice Location Address
First Line : 561 CONGRESS ST
Second Line :
City : PORTLAND
State : ME
Zip : 04101-3308
Country : US
Telephone Number : 207-536-4968
Fax Number : 207-213-4116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2014
Last Update Date : 08/21/2023

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Directions to “ JULIE CATHERINE PETTIT-LANE DPT” Practice Location

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