Provider Demographics
NPI:1730327792
Name:MAINELY KIDZ PT
Entity type:Organization
Organization Name:MAINELY KIDZ PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-439-5104
Mailing Address - Street 1:205 BOLT HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1942
Mailing Address - Country:US
Mailing Address - Phone:207-439-5104
Mailing Address - Fax:207-571-8134
Practice Address - Street 1:205 BOLT HILL RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1942
Practice Address - Country:US
Practice Address - Phone:207-439-5104
Practice Address - Fax:207-571-8134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1834261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy