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General NPI Number Information
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NPI Number | 1093194508
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Entity Type | Organization
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Legal Business Name | STEPPING FORWARD PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 05/29/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 13 BROCK AVE
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City | SANFORD
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State | ME
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Zip | 04073-1927
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Country | US
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Telephone | 207-459-4716
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BROCK AVE
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City | SANFORD
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State | ME
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Zip | 04073-1927
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Country | US
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Telephone | 207-459-4716
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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 | MRS. NICHOLE MARIE TREMBLAY
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Credential | P.T.
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Telephone | 207-459-4716
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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 | PT1381
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License Number State | ME
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