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General NPI Number Information
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NPI Number | 1043089592
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MOTION PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 32 PARKWAY UNIT 4
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City | BETHEL
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State | ME
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Zip | 04217
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Country | US
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Telephone | 207-776-3694
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Fax |
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Provider Business Mailing Address
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Address Line | 381 ROWE HILL RD
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City | GREENWOOD
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State | ME
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Zip | 04255-3516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | BENJAMIN ELLIS
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Credential |
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Telephone | 207-776-3694
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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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