Healthcare Provider Details

I. General information

NPI: 1184493751
Provider Name (Legal Business Name): GOALBOUND PHYSICAL THERAPY AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2023
Last Update Date: 12/25/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 GRAY RD
FALMOUTH ME
04105-2024
US

IV. Provider business mailing address

60 GRAY RD
FALMOUTH ME
04105-2024
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-5421
  • Fax:
Mailing address:
  • Phone: 207-200-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LIAM BRYANT
Title or Position: OWNER/FOUNDER
Credential: DPT
Phone: 207-200-5421