Healthcare Provider Details

I. General information

NPI: 1700700689
Provider Name (Legal Business Name): MARY ELIZABETH BASHAW PT, DPT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILTON RD
ROCHESTER NH
03868-8615
US

IV. Provider business mailing address

4 GATEWAY BLVD UNIT 203
SCARBOROUGH ME
04074-5567
US

V. Phone/Fax

Practice location:
  • Phone: 603-403-1568
  • Fax: 866-307-9993
Mailing address:
  • Phone: 603-403-1568
  • Fax: 866-307-9993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: