Provider Demographics
NPI:1386177459
Name:MANUAL PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:MANUAL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:207-740-3222
Mailing Address - Street 1:871 COURT ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3903
Mailing Address - Country:US
Mailing Address - Phone:207-740-3222
Mailing Address - Fax:207-241-2960
Practice Address - Street 1:871 COURT ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3903
Practice Address - Country:US
Practice Address - Phone:207-740-3222
Practice Address - Fax:207-241-2960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty