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General NPI Number Information
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NPI Number | 1528436052
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Entity Type | Organization
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Legal Business Name | PORTLAND PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 1020 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04102-2718
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Country | US
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Telephone | 78-284-4552
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Fax | 78-284-4532
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Provider Business Mailing Address
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Address Line | 1020 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04102-2718
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Country | US
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Telephone | 207-828-4455
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Fax | 207-828-4453
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SARAH SMITH
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Credential |
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Telephone | 207-828-4455
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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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