Provider Demographics
NPI:1043973589
Name:PREFERRED THERAPY OUTPATIENT SERVICES OF ME, LLC
Entity Type:Organization
Organization Name:PREFERRED THERAPY OUTPATIENT SERVICES OF ME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERCOCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-918-4742
Mailing Address - Street 1:850 SILAS DEANE HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3440
Mailing Address - Country:US
Mailing Address - Phone:860-610-0400
Mailing Address - Fax:860-610-0007
Practice Address - Street 1:142 NEPTUNE DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2882
Practice Address - Country:US
Practice Address - Phone:860-610-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty