Provider Demographics
NPI:1972210086
Name:PORT THERAPY
Entity Type:Organization
Organization Name:PORT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-356-0054
Mailing Address - Street 1:332 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04496-3008
Mailing Address - Country:US
Mailing Address - Phone:207-356-0054
Mailing Address - Fax:
Practice Address - Street 1:6 MINES RD UNIT E1
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-6408
Practice Address - Country:US
Practice Address - Phone:207-691-2963
Practice Address - Fax:207-888-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy