Provider Demographics
NPI:1588959647
Name:TARDIF COMMUNITY THERAPY & WELLNESS PA
Entity type:Organization
Organization Name:TARDIF COMMUNITY THERAPY & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:TARDIF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-862-5709
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-0227
Mailing Address - Country:US
Mailing Address - Phone:207-862-5709
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN ROAD NORTH
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-0227
Practice Address - Country:US
Practice Address - Phone:207-862-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty