Healthcare Provider Details

I. General information

NPI: 1801244801
Provider Name (Legal Business Name): FOUNDATIONS PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 US ROUTE 1 SUITE 180
FALMOUTH ME
04105-2154
US

IV. Provider business mailing address

170 US ROUTE 1 SUITE 180
FALMOUTH ME
04105-2154
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 TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC52330
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT1672
License Number StateME

VIII. Authorized Official

Name: MRS. KERRY AR VOLK
Title or Position: MEMBER
Credential: MSPT, BOCO
Phone: 207-781-5369