Healthcare Provider Details

I. General information

NPI: 1316983257
Provider Name (Legal Business Name): MASSABESIC HEALTH RESOURCES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 MAIN ST
WATERBORO ME
04087-3057
US

IV. Provider business mailing address

PO BOX 456
WATERBORO ME
04087-0456
US

V. Phone/Fax

Practice location:
  • Phone: 207-247-3216
  • Fax: 207-247-3217
Mailing address:
  • Phone: 207-247-3216
  • Fax: 207-247-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRENDA EDGERLY
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-247-3216