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General NPI Number Information
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NPI Number | 1417967415
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Entity Type | Individual
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Provider Name | BRENDA MATTSON PT BOCO
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 170 US ROUTE ONE SUITE 180
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City | FALMOUTH
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State | ME
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Zip | 04105
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Country | US
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Telephone | 207-781-5369
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Fax | 207-781-5862
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Provider Business Mailing Address
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Address Line | 19 PHILLIPS ROAD
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City | FALMOUTH
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State | ME
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Zip | 04105
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Country | US
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Telephone | 207-781-5369
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Fax | 207-781-5862
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | C15212
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0512
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License Number State | ME
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