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General NPI Number Information
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NPI Number | 1023004165
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Entity Type | Organization
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Legal Business Name | PINE TREE PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 760 UNION ST
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City | BANGOR
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State | ME
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Zip | 04401-3125
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Country | US
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Telephone | 207-942-2266
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Fax | 207-942-7577
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Provider Business Mailing Address
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Address Line | 760 UNION ST
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City | BANGOR
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State | ME
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Zip | 04401-3125
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Country | US
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Telephone | 207-942-2266
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Fax | 207-942-7577
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. CHRISTY L. STOUT
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Credential | M.S., P.T.
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Telephone | 207-942-2266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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