Provider Demographics
NPI:1851880603
Name:DBA CENTRAL MAINE CONDITIONING CLINIC
Entity Type:Organization
Organization Name:DBA CENTRAL MAINE CONDITIONING CLINIC
Other - Org Name:HILLTOP COMMUNITY SPORTS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:HEAD LMT
Authorized Official - Prefix:MS
Authorized Official - First Name:KERSTEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:207-783-0018
Mailing Address - Street 1:30 BELGRADE AVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-783-0018
Mailing Address - Fax:207-783-0019
Practice Address - Street 1:30 BELGRADE AVE SUITE A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-783-0018
Practice Address - Fax:207-783-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty