Provider Demographics
NPI:1679554471
Name:EMDE, JEFFREY DEAN (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DEAN
Last Name:EMDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3310
Mailing Address - Country:US
Mailing Address - Phone:207-373-2293
Mailing Address - Fax:207-373-2197
Practice Address - Street 1:329 MAINE ST.
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3040
Practice Address - Country:US
Practice Address - Phone:207-373-2293
Practice Address - Fax:207-373-2197
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT22372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic