Healthcare Provider Details

I. General information

NPI: 1144313081
Provider Name (Legal Business Name): PCHC PHYSICAL THERAPY AND BALANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SUMMER ST
BANGOR ME
04401-6467
US

IV. Provider business mailing address

1048 UNION ST SUITE 5
BANGOR ME
04401-8600
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-5247
  • Fax: 207-992-2154
Mailing address:
  • Phone: 207-992-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS KOHL
Title or Position: CFO
Credential:
Phone: 207-945-5247