MEDICARE: STAGG PERFORMANCE PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1699633420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAGG PERFORMANCE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	200 EXPEDITION DR STE 1A
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-5514
Country	:	US
Telephone Number	:	207-205-0853
Fax Number	:	877-685-0065

Provider Business Practice Location Address
First Line	:	200 EXPEDITION DR STE 1A
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-5514
Country	:	US
Telephone Number	:	207-205-0853
Fax Number	:	877-685-0065

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BRIANNA STAGG
Credential	:	DPT
Telephone Number	:	207-205-0853

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “STAGG PERFORMANCE PHYSICAL THERAPY ” Practice Location

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