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General NPI Number Information
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NPI Number | 1699875674
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Entity Type | Organization
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Legal Business Name | SOUTHERN MAINE PHYSICAL THERAPY
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 449 COTTAGE RD
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4924
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Country | US
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Telephone | 207-799-9700
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Fax | 207-799-9706
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Provider Business Mailing Address
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Address Line | 449 COTTAGE RD
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4924
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Country | US
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Telephone | 207-799-9700
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Fax | 207-799-9706
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRENDA AYRE
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Credential | PT/OWNER
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Telephone | 207-799-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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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 |
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License Number State | ME
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