Provider Demographics
NPI:1356446629
Name:TARDIF, MICHAEL P (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:TARDIF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-0227
Mailing Address - Country:US
Mailing Address - Phone:207-974-6479
Mailing Address - Fax:
Practice Address - Street 1:11 MAIN RD NORTH
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1334
Practice Address - Country:US
Practice Address - Phone:207-974-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist