Healthcare Provider Details

I. General information

NPI: 1982672671
Provider Name (Legal Business Name): MATTHEW S DOUGLAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FOREST FALLS DR SUITE 2
YARMOUTH ME
04096-6937
US

IV. Provider business mailing address

50 FOREST FALLS DRIVE SUITE 2
YARMOUTH ME
04096
US

V. Phone/Fax

Practice location:
  • Phone: 207-846-8725
  • Fax: 207-846-8728
Mailing address:
  • Phone: 207-846-8725
  • Fax: 207-846-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1176
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: