Healthcare Provider Details

I. General information

NPI: 1215919790
Provider Name (Legal Business Name): DEBORAH A SIX PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CORINNA RD
DEXTER ME
04930-2040
US

IV. Provider business mailing address

94 MAIN ST
GORHAM ME
04038-1340
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-4042
  • Fax: 207-992-4043
Mailing address:
  • Phone: 207-839-5860
  • Fax: 207-839-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number731
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT731
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: