Healthcare Provider Details

I. General information

NPI: 1477738391
Provider Name (Legal Business Name): TIMOTHY PATRICK GRIFFIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SEWALL ST SUITE 101
PORTLAND ME
04102-2645
US

IV. Provider business mailing address

73 NEWTON RD SUITE 101
PLAISTOW NH
03865-2424
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-7662
  • Fax:
Mailing address:
  • Phone: 978-388-7272
  • Fax: 978-388-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number1430
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1430
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1430
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: