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NPI Code Detail

MEDICARE: JACK JAMES LAFRENIERE PT, DPT

MEDICARE: JACK JAMES LAFRENIERE PT, DPT
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
1225100000XPhysical TherapistPT7092ME

General Provider Information

NPI Number : 1952255465
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK JAMES LAFRENIERE PT, DPT
Provider Business Mailing Address
First Line : 119 GANNETT DR
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-6942
Country : US
Telephone Number : 207-773-0040
Fax Number :
Provider Business Practice Location Address
First Line : 119 GANNETT DR
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-6942
Country : US
Telephone Number : 207-773-0040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2026
Last Update Date : 02/23/2026

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