MEDICARE: CORE PHYSICAL THERAPY, PA

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	PT1419	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041071	OTHER	ME	ANTHEM
2	M198161	OTHER	ME	CIGNA
3	MN1386	OTHER	ME	HARVARD PILGRIM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2520150	OTHER	ME	AETNA

General Provider Information

NPI Number	:	1871558171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE PHYSICAL THERAPY, PA

Provider Business Mailing Address
First Line	:	PO BOX 221
Second Line	:
City	:	MONMOUTH
State	:	ME
Zip	:	04259-0221
Country	:	US
Telephone Number	:	207-933-6976
Fax Number	:	207-933-6978

Provider Business Practice Location Address
First Line	:	392 ROUTE 202
Second Line	:
City	:	MONMOUTH
State	:	ME
Zip	:	04259
Country	:	US
Telephone Number	:	207-933-6976
Fax Number	:	207-933-6978

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DONNA W DOUGLASS
Credential	:	PT
Telephone Number	:	207-933-6976

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	10/12/2011

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Directions to “CORE PHYSICAL THERAPY, PA ” Practice Location

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