Provider Demographics
NPI:1639697345
Name:PHYSICAL THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS, LLC
Other - Org Name:RESOLVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:508-488-8233
Mailing Address - Street 1:109 SUNSET AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5222
Practice Address - Country:US
Practice Address - Phone:207-623-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty