Provider Demographics
NPI:1689784282
Name:MORIN, BRIAN (PTA, ATC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MORIN
Suffix:
Gender:M
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 BUCK ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2201
Mailing Address - Country:US
Mailing Address - Phone:207-650-2591
Mailing Address - Fax:
Practice Address - Street 1:111 OSSIPEE TRL E
Practice Address - Street 2:SUITE 1151
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6464
Practice Address - Country:US
Practice Address - Phone:207-642-5325
Practice Address - Fax:207-642-5395
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MEPA3126225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAT211OtherLICENSE #