=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588268023
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORE THAN THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2020
-----------------------------------------------------
Last Update Date | 04/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 2ND ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-6133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-217-0803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 19
-----------------------------------------------------
City | HOLDEN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04429-0019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-217-0803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | HEIDI L NILES
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 207-907-0744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------