Healthcare Provider Details

I. General information

NPI: 1891369716
Provider Name (Legal Business Name): MOUNTAIN RANGE OF MOTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 THURSTON HILL ROAD
MADISON ME
04950
US

IV. Provider business mailing address

1120 THURSTON HILL ROAD
MADISON ME
04950
US

V. Phone/Fax

Practice location:
  • Phone: 207-696-3688
  • Fax:
Mailing address:
  • Phone: 207-696-3688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA JEAN BUJA
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 207-696-3688