Healthcare Provider Details

I. General information

NPI: 1881876506
Provider Name (Legal Business Name): KIRSTEN F BERTHIAUME P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MARKET PLACE DR
YORK ME
03909-1682
US

IV. Provider business mailing address

19 FOLSOM DR
NEWMARKET NH
03857-2050
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-3078
  • Fax:
Mailing address:
  • Phone: 603-659-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1990
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: