Provider Demographics
NPI:1093836314
Name:ON THE MEND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ON THE MEND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-455-4539
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04757-0203
Mailing Address - Country:US
Mailing Address - Phone:207-455-4539
Mailing Address - Fax:
Practice Address - Street 1:584 HAYSTACK RD
Practice Address - Street 2:
Practice Address - City:CASTLE HILL
Practice Address - State:ME
Practice Address - Zip Code:04757
Practice Address - Country:US
Practice Address - Phone:207-455-4539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty