Provider Demographics
NPI:1730807116
Name:POIRIER, CASEY (DPT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:POIRIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HERSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4508
Mailing Address - Country:US
Mailing Address - Phone:603-660-3562
Mailing Address - Fax:
Practice Address - Street 1:400 ENTERPRISE DR STE 4
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7663
Practice Address - Country:US
Practice Address - Phone:207-303-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist