Provider Demographics
NPI:1992295513
Name:DIRIGO PHYSICAL THERAPY AND PERFORMANCE
Entity type:Organization
Organization Name:DIRIGO PHYSICAL THERAPY AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:F
Authorized Official - Last Name:BECKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:207-536-4968
Mailing Address - Street 1:561 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3308
Mailing Address - Country:US
Mailing Address - Phone:207-536-4968
Mailing Address - Fax:207-213-4116
Practice Address - Street 1:561 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3308
Practice Address - Country:US
Practice Address - Phone:207-536-4968
Practice Address - Fax:207-213-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy