Provider Demographics
NPI:1821873506
Name:PRIDE IN MOVEMENT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRIDE IN MOVEMENT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:OSTEN
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:207-232-5062
Mailing Address - Street 1:101 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3811
Mailing Address - Country:US
Mailing Address - Phone:207-232-5062
Mailing Address - Fax:
Practice Address - Street 1:101 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3811
Practice Address - Country:US
Practice Address - Phone:207-232-5062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy