Healthcare Provider Details

I. General information

NPI: 1225134646
Provider Name (Legal Business Name): MARNIE ELIZABETH ALLEN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARNIE ELIZABETH CARAMORE MPT

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 SILVER ST
WATERVILLE ME
04901-5813
US

IV. Provider business mailing address

149 SILVER ST
WATERVILLE ME
04901-5813
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-4638
  • Fax: 207-873-1541
Mailing address:
  • Phone: 207-873-4638
  • Fax: 207-873-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3045
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: