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General NPI Number Information
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NPI Number | 1891810412
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Entity Type | Organization
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Legal Business Name | MAINE CENTERS FOR HEALTHCARE PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 980 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-3336
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Country | US
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Telephone | 207-347-7853
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Fax | 207-347-7855
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Provider Business Mailing Address
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Address Line | 980 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04103-3336
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Country | US
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Telephone | 207-347-7853
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Fax | 207-347-7855
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Authorized Official
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Title or Position | MEDICAL DIRECTORY
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Name | OWEN B PICKUS
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Credential | D.O.
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Telephone | 207-857-9311
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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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