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General NPI Number Information
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NPI Number | 1972210086
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Entity Type | Organization
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Legal Business Name | PORT THERAPY
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 6 MINES RD UNIT E1
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City | BLUE HILL
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State | ME
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Zip | 04614-6408
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Country | US
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Telephone | 207-691-2963
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Fax | 207-888-2602
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Provider Business Mailing Address
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Address Line | 332 S MAIN ST
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City | WINTERPORT
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State | ME
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Zip | 04496-3008
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Country | US
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Telephone | 207-356-0054
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MEGAN E MORAN
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Credential | DPT
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Telephone | 207-356-0054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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