Provider Demographics
NPI:1275033078
Name:KORU PHYSICAL THERAPY AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:KORU PHYSICAL THERAPY AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:RENA LAMARRE
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-358-8161
Mailing Address - Street 1:14 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2513
Mailing Address - Country:US
Mailing Address - Phone:207-712-2222
Mailing Address - Fax:
Practice Address - Street 1:619 BRIGHTON AVE # 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2323
Practice Address - Country:US
Practice Address - Phone:207-358-8161
Practice Address - Fax:207-352-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3294261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy