1760444996 NPI number — FALMOUTH PHYSICAL THERAPY ASSOC

Table of content: (NPI 1760444996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760444996 NPI number — FALMOUTH PHYSICAL THERAPY ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALMOUTH PHYSICAL THERAPY ASSOC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760444996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6073
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:
04105-7083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-781-2543
Provider Business Mailing Address Fax Number:
207-781-5077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
361 US ROUTE 1
Provider Second Line Business Practice Location Address:
STE 4
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:
207-781-2543
Provider Business Practice Location Address Fax Number:
207-781-5077
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REESE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
207-781-2543

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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)

  • Identifier: 118310000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: M754 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 001779 . This is a "FEDERAL BC/BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: ZL6507 . This is a "BC/BS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1041847 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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