Provider Demographics
NPI:1083890131
Name:DELORME, KATIE S (PT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:S
Last Name:DELORME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:D
Other - Last Name:RHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:190 RIVERSIDE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:49 SPRING ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-885-0011
Practice Address - Fax:207-885-4476
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME252950099Medicaid
MEMM251602Medicare PIN
ME252950099Medicaid
MEMM251602Medicare PIN