=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033733860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE FLAHERTY FLEURENT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2020
-----------------------------------------------------
Last Update Date | 01/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 259 MAIN ST
-----------------------------------------------------
City | YARMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04096-6723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-780-8860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 GANNETT DR STE C
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-828-0361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081S0010X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | PT5620
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT5620
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------