Provider Demographics
NPI:1255675286
Name:FOUNDATIONS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:FOUNDATIONS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:207-899-4307
Mailing Address - Street 1:4 FUNDY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1777
Mailing Address - Country:US
Mailing Address - Phone:207-899-4307
Mailing Address - Fax:207-899-4312
Practice Address - Street 1:4 FUNDY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1777
Practice Address - Country:US
Practice Address - Phone:207-899-4307
Practice Address - Fax:207-899-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty