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General NPI Number Information
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NPI Number | 1275117533
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Entity Type | Organization
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Legal Business Name | PURE DRIVE PHYSIO & PERFORMANCE, LLC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 1090 US ROUTE 1
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City | YORK
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State | ME
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Zip | 03909-5821
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Country | US
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Telephone | 207-200-1692
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Fax |
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Provider Business Mailing Address
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Address Line | 21 WYNMOOR DR
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9186
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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 | OWNER
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Name | JOSEPH W ORBACZEWSKI
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Credential |
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Telephone | 609-204-9540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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