Provider Demographics
NPI:1871558171
Name:CORE PHYSICAL THERAPY, PA
Entity type:Organization
Organization Name:CORE PHYSICAL THERAPY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOUGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-933-6976
Mailing Address - Street 1:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04259-0221
Mailing Address - Country:US
Mailing Address - Phone:207-933-6976
Mailing Address - Fax:207-933-6978
Practice Address - Street 1:392 ROUTE 202
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259
Practice Address - Country:US
Practice Address - Phone:207-933-6976
Practice Address - Fax:207-933-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME041071OtherANTHEM
MEM198161OtherCIGNA
MEMN1386OtherHARVARD PILGRIM
ME134850000Medicaid
ME2520150OtherAETNA
ME134850000Medicaid
ME2520150OtherAETNA