Provider Demographics
NPI:1023004165
Name:PINE TREE PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PINE TREE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:207-942-2266
Mailing Address - Street 1:760 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3125
Mailing Address - Country:US
Mailing Address - Phone:207-942-2266
Mailing Address - Fax:207-942-7577
Practice Address - Street 1:760 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3125
Practice Address - Country:US
Practice Address - Phone:207-942-2266
Practice Address - Fax:207-942-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty