Provider Demographics
NPI:1225168339
Name:GLENN J. FLAMING MPT
Entity Type:Organization
Organization Name:GLENN J. FLAMING MPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLAMING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-442-9810
Mailing Address - Street 1:10 BRACKETT RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04342-4001
Mailing Address - Country:US
Mailing Address - Phone:207-442-9810
Mailing Address - Fax:207-443-9189
Practice Address - Street 1:361 HIGH ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1737
Practice Address - Country:US
Practice Address - Phone:207-442-9810
Practice Address - Fax:207-443-9189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2905490OtherCIGNA
ME048924OtherANTHEM BX BS
ME2274762OtherAETNA
MEMN2352OtherHARVARD PILGRIM
MEMN2352OtherHARVARD PILGRIM