Provider Demographics
NPI:1659983021
Name:RESILIENCE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RESILIENCE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-707-1409
Mailing Address - Street 1:32 SUNDERLAND DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-9233
Mailing Address - Country:US
Mailing Address - Phone:207-707-1409
Mailing Address - Fax:
Practice Address - Street 1:23 ALDRICH AVE
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5709
Practice Address - Country:US
Practice Address - Phone:207-707-1409
Practice Address - Fax:833-544-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy