Healthcare Provider Details

I. General information

NPI: 1154288942
Provider Name (Legal Business Name): AMANDA RUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MILITARY RD
GREENBUSH ME
04418-3137
US

IV. Provider business mailing address

30 BISHOP DR
HERMON ME
04401-0456
US

V. Phone/Fax

Practice location:
  • Phone: 207-826-2000
  • Fax:
Mailing address:
  • Phone: 207-217-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA4719
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: