Provider Demographics
NPI:1841381290
Name:PORT CITY PHYSICAL THERAPY LIMITED
Entity Type:Organization
Organization Name:PORT CITY PHYSICAL THERAPY LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP,AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:94 AUBURN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94 AUBURN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2141
Practice Address - Country:US
Practice Address - Phone:207-797-7578
Practice Address - Fax:207-797-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME206528Medicare Oscar/Certification