=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780720128
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIGITTE J MASSEY PHYSICAL THERAPIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 COLLEGE AVE ORTHOPEDIC THERAPY ASSOCIATES
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-6226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-873-5503
-----------------------------------------------------
Fax | 270-877-0920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 FOREST PARK
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-5168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-873-9925
-----------------------------------------------------
Fax | 207-877-0290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT630
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------