=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831798610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE CERMINARO PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2020
-----------------------------------------------------
Last Update Date | 11/16/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 181 MAIN ST
-----------------------------------------------------
City | NORWAY
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04268-5664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-744-6160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 333
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04216-0333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-204-6210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------