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General NPI Number Information
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NPI Number | 1700643384
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Entity Type | Organization
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Legal Business Name | INFINITE CAPACITY PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 125 JOHN ROBERTS RD STE 15
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6983
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Country | US
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Telephone | 724-584-3307
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Fax |
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Provider Business Mailing Address
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Address Line | 327 BLACK POINT RD
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City | SCARBOROUGH
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State | ME
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Zip | 04074-8677
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Country | US
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Telephone | 724-584-3307
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL DALLATORE
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Credential | PT, DPT
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Telephone | 724-584-3307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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