Provider Demographics
NPI:1154536472
Name:SOUTHERN MAINE PHYSICAL THERAPY, PA
Entity type:Organization
Organization Name:SOUTHERN MAINE PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-854-1239
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0310
Mailing Address - Country:US
Mailing Address - Phone:207-854-1239
Mailing Address - Fax:207-854-1230
Practice Address - Street 1:449 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4924
Practice Address - Country:US
Practice Address - Phone:207-799-9700
Practice Address - Fax:207-799-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040910OtherANTHEM BCBS
MEMNT112OtherHARVARD PILGRIM
ME2433023OtherAETNA
ME2433023OtherAETNA