Healthcare Provider Details

I. General information

NPI: 1467488890
Provider Name (Legal Business Name): ORTHOPAEDIC PHYSICAL THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 MAIN ST SUITE A
SANFORD ME
04073
US

IV. Provider business mailing address

1068 MAIN ST SUITE A
SANFORD ME
04073-3606
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-6789
  • Fax: 207-324-9394
Mailing address:
  • Phone: 207-324-6789
  • Fax: 207-324-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH NEIL SIMONS
Title or Position: PRESIDENT
Credential: PT, DPT, MS,OCS
Phone: 207-324-6789