Healthcare Provider Details

I. General information

NPI: 1417967415
Provider Name (Legal Business Name): BRENDA MATTSON PT BOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA MATTSON HARFIELD PT BOCO

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 US ROUTE ONE SUITE 180
FALMOUTH ME
04105
US

IV. Provider business mailing address

19 PHILLIPS ROAD
FALMOUTH ME
04105
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-5369
  • Fax: 207-781-5862
Mailing address:
  • Phone: 207-781-5369
  • Fax: 207-781-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC15212
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0512
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: