Provider Demographics
NPI:1184227084
Name:HAVEN PHYSICAL THERAPY AND PELVIC HEALTH LLC
Entity Type:Organization
Organization Name:HAVEN PHYSICAL THERAPY AND PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:MARNY
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:WITAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-632-9655
Mailing Address - Street 1:251 US ROUTE 1 STE 9
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1322
Mailing Address - Country:US
Mailing Address - Phone:207-632-9655
Mailing Address - Fax:
Practice Address - Street 1:251 US ROUTE 1 STE 9
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1322
Practice Address - Country:US
Practice Address - Phone:207-632-9655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy