1134311970 NPI number — MRS. THERESA PURINGTON FREEMAN PT LMT

Table of content: MRS. THERESA PURINGTON FREEMAN PT LMT (NPI 1134311970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134311970 NPI number — MRS. THERESA PURINGTON FREEMAN PT LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
THERESA
Provider Middle Name:
PURINGTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PURINGTON
Provider Other First Name:
THERESA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT LMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134311970
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PHILLIPS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-781-6191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 FUNDY RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-781-6191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT829 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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