Provider Demographics
NPI:1578945374
Name:BARRY, MARLENE (MSPT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GANNETT DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5900
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:INTERMED ON SITE AT LLBEAN OFC SOUTHEND
Practice Address - Street 2:7 CAMPUS DRIVE
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04033-0001
Practice Address - Country:US
Practice Address - Phone:207-552-7452
Practice Address - Fax:207-552-7129
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist