Provider Demographics
NPI:1447254057
Name:DENTON, ROBERT R (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:DENTON
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 1:1250 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1884
Mailing Address - Country:US
Mailing Address - Phone:207-878-2244
Mailing Address - Fax:207-878-5548
Practice Address - Street 1:1250 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1884
Practice Address - Country:US
Practice Address - Phone:207-878-2244
Practice Address - Fax:207-878-5548
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
027296OtherBLUE CROSS
650015984OtherRR MEDICARE
001377970OtherUNITED
131760199OtherMAINE CARE (BOX 24)
1040915OtherAETNA (REF)
1042586OtherAETNA (BILLING)
131760000OtherMAINE CARE (BOX 33)
A-135870OtherHEALTH EOS
AA15471OtherHARVARD PILGRIM
6627796OtherCIGNA
A-135870OtherMULTI PLAN
MM2430Medicare ID - Type Unspecified