Healthcare Provider Details

I. General information

NPI: 1851543177
Provider Name (Legal Business Name): PORT CITY PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 AUBURN ST STE 3
PORTLAND ME
04103-2141
US

IV. Provider business mailing address

94 AUBURN ST STE 3
PORTLAND ME
04103-2141
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JANNA KING
Title or Position: VP, AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000