Healthcare Provider Details

I. General information

NPI: 1811069040
Provider Name (Legal Business Name): CATHERINE DENISE BALENTINE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL DR
YORK ME
03909-1011
US

IV. Provider business mailing address

164 YORK WOODS RD
SOUTH BERWICK ME
03908-2168
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-4321
  • Fax:
Mailing address:
  • Phone: 603-812-6112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT3657
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: