MEDICARE: LAURA MCGRATH 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	225100000X	Physical Therapist	PT3044	ME

General Provider Information

NPI Number	:	1346556610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAURA MCGRATH LLC

Provider Business Mailing Address
First Line	:	1218 SHORE RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-2123
Country	:	US
Telephone Number	:	207-671-4884
Fax Number	:	207-772-7644

Provider Business Practice Location Address
First Line	:	1218 SHORE RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-2123
Country	:	US
Telephone Number	:	207-671-4884
Fax Number	:	207-772-7644

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	SUSAN MCKINLEY
Credential	:
Telephone Number	:	207-939-7072

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	04/15/2015

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Directions to “LAURA MCGRATH LLC ” Practice Location

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