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General NPI Number Information
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NPI Number | 1841669660
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Entity Type | Organization
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Legal Business Name | MAINE STRONG PHYSICAL THERAPY PA
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 297 SAWYER ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2946
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Country | US
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Telephone | 207-400-7604
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Fax |
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Provider Business Mailing Address
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Address Line | 297 SAWYER ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2946
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Country | US
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Telephone | 207-400-7604
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON ADOUR
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Credential |
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Telephone | 207-400-7604
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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 | PT4165
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License Number State | ME
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