Provider Demographics
NPI:1891369716
Name:MOUNTAIN RANGE OF MOTION, LLC
Entity Type:Organization
Organization Name:MOUNTAIN RANGE OF MOTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BUJA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:207-696-3688
Mailing Address - Street 1:1120 THURSTON HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950
Mailing Address - Country:US
Mailing Address - Phone:207-696-3688
Mailing Address - Fax:
Practice Address - Street 1:1120 THURSTON HILL ROAD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950
Practice Address - Country:US
Practice Address - Phone:207-696-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-15
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty