Healthcare Provider Details

I. General information

NPI: 1144139890
Provider Name (Legal Business Name): SCOTT KARL STACKHOUSE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WATER ST
KENNEBUNK ME
04043-7034
US

IV. Provider business mailing address

19 PLEASANT ST
KENNEBUNK ME
04043-6825
US

V. Phone/Fax

Practice location:
  • Phone: 207-216-7662
  • Fax:
Mailing address:
  • Phone: 302-983-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5264
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: