1891810412 NPI number — MAINE CENTERS FOR HEALTHCARE PHYSICAL THERAPY

Table of content: MS. LAUREN IRENE RYSKEY LLPC (NPI 1720774417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891810412 NPI number — MAINE CENTERS FOR HEALTHCARE PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAINE CENTERS FOR HEALTHCARE PHYSICAL THERAPY
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:
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:
1891810412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
980 FOREST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04103-3336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-347-7853
Provider Business Mailing Address Fax Number:
207-347-7855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04103-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-347-7853
Provider Business Practice Location Address Fax Number:
207-347-7855
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PICKUS
Authorized Official First Name:
OWEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MEDICAL DIRECTORY
Authorized Official Telephone Number:
207-857-9311

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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