Healthcare Provider Details

I. General information

NPI: 1841381290
Provider Name (Legal Business Name): PORT CITY PHYSICAL THERAPY LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 AUBURN ST SUITE 3
PORTLAND ME
04103-2141
US

IV. Provider business mailing address

94 AUBURN ST SUITE 3
PORTLAND ME
04103-2141
US

V. Phone/Fax

Practice location:
  • Phone: 207-797-7578
  • Fax: 207-797-8165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP,AUTHORIZED OFFICIAL
Credential: JD
Phone: 713-297-7000