Basic Information
| Provider Information | |||||||||
| NPI: | 1861469082 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RESULTS PHYSICAL AND OCCUPATIONAL THERAPY | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | EXUBERANT LIVING PA | ||||||||
| OtherOrganizationType: | 4 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 216 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | DIXMONT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049323212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079924042 | ||||||||
| FaxNumber: | 2079924043 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | DIXMONT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049323212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079924042 | ||||||||
| FaxNumber: | 2079924043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LANE | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2079924042 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT1423 | ME | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | PT1665 | ME | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | OT1929 | ME | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | OT1818 | ME | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | PT2697 | ME | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | OT790 | ME | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 037494 | 01 | ME | BLUE CROSS BLUE SHIELD | OTHER |