Provider Demographics
NPI:1164700175
Name:HARMON, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CONGRESS AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-1536
Mailing Address - Country:US
Mailing Address - Phone:207-386-0351
Mailing Address - Fax:207-386-0181
Practice Address - Street 1:48 TANDBERG TRL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-6402
Practice Address - Country:US
Practice Address - Phone:207-892-3952
Practice Address - Fax:207-892-4678
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA70000025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant