Provider Demographics
NPI:1528389319
Name:SEABLUE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SEABLUE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-706-6076
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-0165
Mailing Address - Country:US
Mailing Address - Phone:207-706-6076
Mailing Address - Fax:877-807-8994
Practice Address - Street 1:67 ATLANTIC HWY
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:ME
Practice Address - Zip Code:04849
Practice Address - Country:US
Practice Address - Phone:207-706-6076
Practice Address - Fax:877-807-8994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy