Provider Demographics
NPI:1770642423
Name:HANEY, MARJORIE AMPORN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:AMPORN
Last Name:HANEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:AMPORN
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SCARBOROUGH PHYSICAL THERAPY ASSOCIATES
Mailing Address - Street 2:51 US ROUTE ONE
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-883-1227
Mailing Address - Fax:207-883-6199
Practice Address - Street 1:SCARBOROUGH PHYSICAL THERAPY ASSOCIATES
Practice Address - Street 2:51 US ROUTE ONE
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-1227
Practice Address - Fax:207-883-6199
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME650009113OtherRR MEDICARE
ME061246OtherANTHEM
ME432001499Medicaid
ME061246OtherANTHEM