Provider Demographics
NPI:1720636913
Name:CORMIER, EMILY LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LYNN
Last Name:CORMIER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MECHANIC FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04256-5701
Mailing Address - Country:US
Mailing Address - Phone:207-346-1654
Mailing Address - Fax:
Practice Address - Street 1:2 SHELDRON DRIVE
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753
Practice Address - Country:US
Practice Address - Phone:607-746-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist