Healthcare Provider Details

I. General information

NPI: 1801337563
Provider Name (Legal Business Name): FIT PHYSICAL THERAPY AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 HAMEL LN
OLD TOWN ME
04468-1949
US

IV. Provider business mailing address

11 HAMEL LN
OLD TOWN ME
04468-1949
US

V. Phone/Fax

Practice location:
  • Phone: 207-944-7020
  • Fax:
Mailing address:
  • Phone: 207-944-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. RANDY KENNETH CYR JR.
Title or Position: OWNER, PRESIDENT
Credential: PT
Phone: 207-944-7020