Provider Demographics
NPI:1346261070
Name:CASCO BAY PHYSICAL THERAPY PA
Entity Type:Organization
Organization Name:CASCO BAY PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-781-5540
Mailing Address - Street 1:367 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1350
Mailing Address - Country:US
Mailing Address - Phone:207-781-5540
Mailing Address - Fax:207-781-5542
Practice Address - Street 1:367 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1350
Practice Address - Country:US
Practice Address - Phone:207-781-5540
Practice Address - Fax:207-781-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7921Medicare PIN