Basic Information
Provider Information | |||||||||
NPI: | 1992289862 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROBERTS | ||||||||
FirstName: | CAROLYN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PHYSICAL THERAPIST | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARROWS | ||||||||
OtherFirstName: | CAROLYN | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 15 HOSPITAL DRIVE | ||||||||
Address2: |   | ||||||||
City: | YORK | ||||||||
State: | ME | ||||||||
PostalCode: | 039091011 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2073512478 | ||||||||
FaxNumber: | 2073512216 | ||||||||
Practice Location | |||||||||
Address1: | 112 SANFORD RD | ||||||||
Address2: |   | ||||||||
City: | WELLS | ||||||||
State: | ME | ||||||||
PostalCode: | 040905533 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2076460373 | ||||||||
FaxNumber: | 2076460381 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/18/2018 | ||||||||
LastUpdateDate: | 04/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5235 | ME | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | PT5235 | 01 | ME | PHYSICAL THERAPY LICENSE | OTHER |