Provider Demographics
NPI:1346344793
Name:DOCKSIDE WELLNESS CENTER
Entity Type:Organization
Organization Name:DOCKSIDE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SCHNEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-495-3195
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:BELGRADE LAKES
Mailing Address - State:ME
Mailing Address - Zip Code:04918-0343
Mailing Address - Country:US
Mailing Address - Phone:207-495-3195
Mailing Address - Fax:207-512-2545
Practice Address - Street 1:47 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BELGRADE LAKES
Practice Address - State:ME
Practice Address - Zip Code:04918-0343
Practice Address - Country:US
Practice Address - Phone:207-495-3195
Practice Address - Fax:207-512-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME413180000Medicaid
ME3856197OtherAETNA
ME099525OtherBC/BS
ME5632339OtherCCN
ME8534395OtherCIGNA
ME8534395OtherCIGNA
ME=========OtherEBPA
ME3856197OtherAETNA