Provider Demographics
NPI:1699809129
Name:ELDRIDGE, BARBARA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-1292
Mailing Address - Country:US
Mailing Address - Phone:207-212-7767
Mailing Address - Fax:
Practice Address - Street 1:33 ROGER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3328
Practice Address - Country:US
Practice Address - Phone:207-784-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist