=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841898632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINE STRONG PHYSICAL THERAPY AND SCOLIOSIS REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2020
-----------------------------------------------------
Last Update Date | 11/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 251 DANFORTH ST UNIT 1
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-707-7955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 SPRING ST APT 1
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-707-7955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPY
-----------------------------------------------------
Name | JOSEPH REID BRIGLIA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 609-707-7955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------