Provider Demographics
NPI:1720035371
Name:PREMIER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIRECT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:R
Authorized Official - Last Name:CREDIT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:207-647-2727
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty