Provider Demographics
NPI:1700833381
Name:GREEN, ERICA POND (PT)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:POND
Last Name:GREEN
Suffix:
Gender:F
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:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-0347
Mailing Address - Country:US
Mailing Address - Phone:207-647-2727
Mailing Address - Fax:207-647-2734
Practice Address - Street 1:316 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4227
Practice Address - Country:US
Practice Address - Phone:207-647-2727
Practice Address - Fax:207-647-2734
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist