Provider Demographics
NPI:1114906385
Name:FLAGG, CHAD A (MPT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:FLAGG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PORTLAND RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6603
Mailing Address - Country:US
Mailing Address - Phone:207-985-6181
Mailing Address - Fax:207-985-6239
Practice Address - Street 1:83 PORTLAND RD
Practice Address - Street 2:SUITE #3
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6603
Practice Address - Country:US
Practice Address - Phone:207-985-6181
Practice Address - Fax:207-985-6239
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist