Provider Demographics
NPI:1205533627
Name:MAYBACH, MAEGAN (DPT)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:
Last Name:MAYBACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-1817
Mailing Address - Country:US
Mailing Address - Phone:401-269-8509
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:207-662-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist