Healthcare Provider Details

I. General information

NPI: 1902087679
Provider Name (Legal Business Name): THOMAS HARRIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

647 US ROUTE 1 STE 201
YORK ME
03909-1651
US

IV. Provider business mailing address

PO BOX 2000
YORK ME
03909-2000
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-7079
  • Fax: 207-363-7700
Mailing address:
  • Phone: 207-363-7079
  • Fax: 207-363-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberME213286
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HARRIGAN
Title or Position: OWNER
Credential:
Phone: 207-363-7079