Provider Demographics
NPI:1225007503
Name:VIRICEL, MICHAEL LOUIS (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LOUIS
Last Name:VIRICEL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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 1:23 BRIDGTON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3653
Practice Address - Country:US
Practice Address - Phone:207-797-3477
Practice Address - Fax:207-797-8577
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPT2543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist