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General NPI Number Information
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NPI Number | 1790419976
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Entity Type | Organization
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Legal Business Name | DEABAY MOBILE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 04/04/2024
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Provider Practice Location Address
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Address Line | 336 MOUNT HOPE AVE STE 9
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City | BANGOR
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State | ME
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Zip | 04401-4236
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Country | US
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Telephone | 207-249-6621
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Fax | 207-512-1254
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Provider Business Mailing Address
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Address Line | 62 GRAHAM AVE S
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City | BANGOR
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State | ME
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Zip | 04401-5879
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Country | US
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Telephone | 207-249-6621
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Fax | 207-512-1254
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ANN COVEY
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Credential |
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Telephone | 207-949-0533
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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 |
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License Number State |
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