Basic Information
| Provider Information | |||||||||
| NPI: | 1063534345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VERONEAU | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | J | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 94 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GORHAM | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040381340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078395860 | ||||||||
| FaxNumber: | 2078392499 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 OCEAN ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041063623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077998226 | ||||||||
| FaxNumber: | 2077999340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT2913 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.