Provider Demographics
NPI:1457495202
Name:SCARBOROUGH FAMILY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SCARBOROUGH FAMILY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:207-883-8133
Mailing Address - Street 1:400 ENTERPRISE DRIVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-8133
Mailing Address - Fax:207-883-8226
Practice Address - Street 1:400 ENTERPRISE DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-8133
Practice Address - Fax:207-883-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2013-02-04
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
022643OtherBCBS
098899OtherBCBS
ME407410000Medicaid
AA32558OtherHARVARD PILGRIM