MEDICARE: PEQUAWKET PHYSICAL THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1134303001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEQUAWKET PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	LIMINGTON
State	:	ME
Zip	:	04049-0190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 JOE WEBSTER RD
Second Line	:	SUITE A
City	:	LIMINGTON
State	:	ME
Zip	:	04049
Country	:	US
Telephone Number	:	207-637-3522
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAULINE M HILL
Credential	:
Telephone Number	:	207-637-3522

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	01/19/2011

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