Provider Demographics
NPI:1043569791
Name:RICH, MICHAEL A (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:CMADEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1920
Mailing Address - Country:US
Mailing Address - Phone:207-230-7093
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 307
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2421
Practice Address - Country:US
Practice Address - Phone:207-593-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT18722251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic