Provider Demographics
NPI:1043089592
Name:MOUNTAIN MOTION PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MOUNTAIN MOTION PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-776-3694
Mailing Address - Street 1:381 ROWE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:ME
Mailing Address - Zip Code:04255-3516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 PARKWAY
Practice Address - Street 2:UNIT 4
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217
Practice Address - Country:US
Practice Address - Phone:207-776-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty