Provider Demographics
NPI:1467488890
Name:ORTHOPAEDIC PHYSICAL THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:ORTHOPAEDIC PHYSICAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MS,OCS
Authorized Official - Phone:207-324-6789
Mailing Address - Street 1:1068 MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3606
Mailing Address - Country:US
Mailing Address - Phone:207-324-6789
Mailing Address - Fax:207-324-9394
Practice Address - Street 1:1068 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-324-6789
Practice Address - Fax:207-324-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMN2093OtherHARVARD PILGRIM
ME134210000Medicaid
ME034720OtherANTHEM
ME134210000Medicaid
ME5161Medicare PIN
ME034720OtherANTHEM