MEDICARE: EMILY MAUCH

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	225100000X	Physical Therapist	5100	ME

General Provider Information

NPI Number	:	1336633965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MAUCH

Provider Business Mailing Address
First Line	:	8 SIMONTON ST
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-3132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 BOWDOIN MILL IS # 220
Second Line	:
City	:	TOPSHAM
State	:	ME
Zip	:	04086-1263
Country	:	US
Telephone Number	:	207-729-1164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	01/03/2019

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Directions to “ EMILY MAUCH ” Practice Location

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