Provider Demographics
NPI:1629454913
Name:MAINE, EMILY ELIZABETH (PT)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:MAINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 PORTOLA RD.
Mailing Address - Street 2:SUITE A2
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8095
Mailing Address - Country:US
Mailing Address - Phone:805-644-1273
Mailing Address - Fax:805-644-4417
Practice Address - Street 1:1879 PORTOLA RD
Practice Address - Street 2:SUITE A2
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6436
Practice Address - Country:US
Practice Address - Phone:805-644-1273
Practice Address - Fax:805-644-4417
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports