Provider Demographics
NPI:1952330235
Name:DUGAL, JEREMY (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:DUGAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BENNETT DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2052
Mailing Address - Country:US
Mailing Address - Phone:207-498-6334
Mailing Address - Fax:207-493-3247
Practice Address - Street 1:118 BENNETT DR
Practice Address - Street 2:SUITE 140
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2052
Practice Address - Country:US
Practice Address - Phone:207-498-6334
Practice Address - Fax:207-493-3247
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0245Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
ME048149OtherANTHEM BC/BS ID NUMBER