Provider Demographics
NPI:1457082968
Name:CENTREBOARD 207 LLC
Entity Type:Organization
Organization Name:CENTREBOARD 207 LLC
Other - Org Name:CENTREBOARD PHYSIOTHERAPY AND MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-370-7118
Mailing Address - Street 1:350A ROUTE 1
Mailing Address - Street 2:STE 1B
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096
Mailing Address - Country:US
Mailing Address - Phone:207-370-7118
Mailing Address - Fax:207-422-7178
Practice Address - Street 1:350A ROUTE 1
Practice Address - Street 2:STE 1B
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096
Practice Address - Country:US
Practice Address - Phone:207-370-7118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty