=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316006737
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCARBOROUGH PHYSICAL THERAPY ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 08/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 51 U.S. ROUTE ONE
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-883-1227
-----------------------------------------------------
Fax | 207-883-6199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51 U.S. ROUTE ONE NONESUCH RIVER PLAZA, SUITE J
-----------------------------------------------------
City | SCARBOROUGH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-883-1227
-----------------------------------------------------
Fax | 207-883-6199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JUNE D TAIT
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 207-883-1227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------