Provider Demographics
NPI:1043500119
Name:HUNTRESS PEDIATRIC THERAPY P.A.
Entity Type:Organization
Organization Name:HUNTRESS PEDIATRIC THERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HUNTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-583-6279
Mailing Address - Street 1:70 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ME
Mailing Address - Zip Code:04040-3427
Mailing Address - Country:US
Mailing Address - Phone:207-583-6279
Mailing Address - Fax:207-583-6279
Practice Address - Street 1:16 MADISON AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3579
Practice Address - Country:US
Practice Address - Phone:207-583-6279
Practice Address - Fax:207-583-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT698252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency