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General NPI Number Information
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NPI Number | 1649280637
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PHYSICAL THERAPY CONNECTION
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 02/21/2008
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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 | PO BOX 66821
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City | FALMOUTH
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State | ME
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Zip | 04105-6821
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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 | OWNER PHYSICAL THERAPIST ORTHOTIST
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Name | MS. BRENDA MATTSON
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Credential | PT BOCO
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Telephone | 207-781-5369
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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 | PT0512
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | C15212
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License Number State | ME
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Taxonomy #3
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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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