Provider Demographics
NPI:1508393786
Name:FOLSOM PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:FOLSOM PHYSICAL THERAPY, LLC
Other - Org Name:FOLSOM PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:207-841-0120
Mailing Address - Street 1:3 UNION ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1946
Mailing Address - Country:US
Mailing Address - Phone:207-841-0120
Mailing Address - Fax:
Practice Address - Street 1:12 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7314
Practice Address - Country:US
Practice Address - Phone:207-841-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOLSOM PHYSICAL THERAPY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME254270099Medicaid