Provider Demographics
NPI:1063622702
Name:ORTHOPAEDIC PHYSICAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:ORTHOPAEDIC PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,MS,OCS
Authorized Official - Phone:207-883-6789
Mailing Address - Street 1:360 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9772
Mailing Address - Country:US
Mailing Address - Phone:207-883-6789
Mailing Address - Fax:207-885-9394
Practice Address - Street 1:360 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9772
Practice Address - Country:US
Practice Address - Phone:207-883-6789
Practice Address - Fax:207-885-9394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTHOPAEDIC PHYSICAL THERAPY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT9662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME048994OtherANTHEM
MEMN2093OtherHARVARD PILGRIM
MEMN2093OtherHARVARD PILGRIM
ME5161Medicare PIN