Healthcare Provider Details

I. General information

NPI: 1992032064
Provider Name (Legal Business Name): READELL ORFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 ROSS RD
KENNEBUNK ME
04043-6532
US

IV. Provider business mailing address

158 ROSS RD
KENNEBUNK ME
04043-6532
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-7141
  • Fax:
Mailing address:
  • Phone: 207-985-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3310
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: