Provider Demographics
NPI:1316006737
Name:SCARBOROUGH PHYSICAL THERAPY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SCARBOROUGH PHYSICAL THERAPY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAIT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-883-1227
Mailing Address - Street 1:51 U.S. ROUTE ONE
Mailing Address - Street 2:NONESUCH RIVER PLAZA, SUITE J
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-1227
Mailing Address - Fax:207-883-6199
Practice Address - Street 1:51 U.S. ROUTE ONE
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-1227
Practice Address - Fax:207-883-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME126700000Medicaid
MECA3341OtherRR MEDICARE
MEQ0859OtherANTHEM
ME126700000Medicaid
MEQ0859OtherANTHEM
MM8667Medicare PIN