Provider Demographics
NPI:1629147459
Name:REID, PAUL ROBERT (MPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:REID
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:910-325-0211
Mailing Address - Fax:910-325-0580
Practice Address - Street 1:775-2 WEST CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584
Practice Address - Country:US
Practice Address - Phone:910-325-0211
Practice Address - Fax:910-325-0580
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP17895OtherPT LICENSE
MD19976OtherLICENSE#